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General NPI Number Information
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NPI Number | 1518925734
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Entity Type | Individual
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Provider Name | SUSAN JEAN WILBER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 2515 BREEZY LN
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City | PANAMA CITY
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State | FL
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Zip | 32405-3938
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Country | US
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Telephone | 910-728-8156
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 BREEZY LN
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City | PANAMA CITY
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State | FL
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Zip | 32405-3938
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Country | US
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Telephone | 910-728-8156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT25185
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 07564
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License Number State | MD
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