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General NPI Number Information
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NPI Number | 1760637029
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Entity Type | Individual
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Provider Name | SUSAN HEDBERG OT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 250 INTERNATIONAL PKWY
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City | LAKE MARY
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State | FL
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Zip | 32746-5030
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Country | US
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Telephone | 407-833-8815
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Fax |
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Provider Business Mailing Address
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Address Line | 438 LAKEPARK TRL
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City | OVIEDO
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State | FL
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Zip | 32765-8274
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Country | US
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Telephone | 407-625-9192
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | OT13267
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT13267
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License Number State | FL
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