=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770026007
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN L ROSSI OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2016
-----------------------------------------------------
Last Update Date | 11/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 N STATE ST
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67654-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-871-1591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 244
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67654-0244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-871-1591
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-00519
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------