MEDICARE: SUSAN PURNELL

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
1	235Z00000X	Speech-Language Pathologist	SL000282L	PA

General Provider Information

NPI Number	:	1568862563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PURNELL

Provider Business Mailing Address
First Line	:	55 TOPAZ DR
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-8660
Country	:	US
Telephone Number	:	717-377-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 OCRACOKE ISLAND CT
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-7422
Country	:	US
Telephone Number	:	717-377-5583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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Directions to “ SUSAN PURNELL ” Practice Location

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