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NPI Code Detail

MEDICARE: MRS. SUSAN DIANE DENETTE

MEDICARE: MRS. SUSAN DIANE DENETTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOTR1313AR

General Provider Information

NPI Number : 1467665521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN DIANE DENETTE
Provider Business Mailing Address
First Line : 106 KATYE LN
Second Line :
City : SHERWOOD
State : AR
Zip : 72120-2733
Country : US
Telephone Number : 501-834-8682
Fax Number :
Provider Business Practice Location Address
First Line : 905 N REDMOND RD
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-3622
Country : US
Telephone Number : 501-982-0528
Fax Number : 501-533-6380
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 09/22/2009

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Directions to “ MRS. SUSAN DIANE DENETTE ” Practice Location

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