=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255102570
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN EFFERTH MS, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2024
-----------------------------------------------------
Last Update Date | 01/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 SPRING RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44109-4460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-838-3150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 ELMWOOD RD
-----------------------------------------------------
City | BAY VILLAGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44140-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-664-0794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------