=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912478256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN ELIZABETH TAPHOUSE OTRL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2018
-----------------------------------------------------
Last Update Date | 12/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16195 BIRD RD
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48451-8533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-516-1819
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16195 BIRD RD
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48451-8533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-516-1819
-----------------------------------------------------
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 | 5201000961
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------