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General NPI Number Information
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NPI Number | 1659518074
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Entity Type | Organization
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Legal Business Name | OH SUSANNAH
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 332 W SUNSET RD SUITE 2B
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City | SAN ANTONIO
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State | TX
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Zip | 78209-1767
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Country | US
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Telephone | 210-386-2296
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Fax | 210-828-3698
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Provider Business Mailing Address
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Address Line | 101 S SKIPPER DR
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7446
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Country | US
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Telephone | 210-386-2296
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Fax | 210-828-3698
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Authorized Official
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Title or Position | MEMBER
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Name | MS. SUSAN L. MORELAND
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Credential | N/A
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Telephone | 210-386-2296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | N/A
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License Number State |
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