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NPI Code Detail

MEDICARE: SUSAN J MAHON M.S.

MEDICARE: SUSAN J MAHON M.S.
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 Therapist1399CA

General Provider Information

NPI Number : 1609930643
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN J MAHON M.S.
Provider Business Mailing Address
First Line : 351 WALLER ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94117-3523
Country : US
Telephone Number : 650-281-6307
Fax Number :
Provider Business Practice Location Address
First Line : 2686 SPRING ST
Second Line :
City : REDWOOD CITY
State : CA
Zip : 94063-3522
Country : US
Telephone Number : 650-839-1944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2006
Last Update Date : 07/08/2007

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