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NPI Code Detail

MEDICARE: SUSAN S GOULD OT/CHT

MEDICARE: SUSAN S GOULD OT/CHT
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 TherapistOT001129GA
2225XH1200XHand Occupational Therapist10011020003GA

General Provider Information

NPI Number : 1679579973
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN S GOULD OT/CHT
Provider Business Mailing Address
First Line : PO BOX 949
Second Line :
City : ROME
State : GA
Zip : 30162-0949
Country : US
Telephone Number : 706-236-2758
Fax Number : 706-802-1408
Provider Business Practice Location Address
First Line : 201 TURNER MCCALL BLVD NW
Second Line :
City : ROME
State : GA
Zip : 30165-2545
Country : US
Telephone Number : 706-236-2758
Fax Number : 706-802-1408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 10/22/2007

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Directions to “ SUSAN S GOULD OT/CHT” Practice Location

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