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General NPI Number Information
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NPI Number | 1609807361
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Entity Type | Individual
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Provider Name | SUSAN PATRICIA CARMONA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 4710 OLD TROY PIKE
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City | DAYTON
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State | OH
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Zip | 45424-5740
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Country | US
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Telephone | 937-855-7821
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Fax | 937-855-6972
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Provider Business Mailing Address
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Address Line | 4710 OLD TROY PIKE
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City | DAYTON
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State | OH
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Zip | 45424-5740
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Country | US
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Telephone | 937-855-7821
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Fax | 937-855-6972
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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 | 004531-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT6693
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License Number State | OH
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