MEDICARE: SUSAN KLEMM SLAUGHTER OT

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	225X00000X	Occupational Therapist	2924	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679583348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KLEMM SLAUGHTER OT

Provider Business Mailing Address
First Line	:	525 QUEENS RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1423
Country	:	US
Telephone Number	:	704-366-4132
Fax Number	:	704-423-5775

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH RD
Second Line	:	SUITE 212
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1032
Country	:	US
Telephone Number	:	704-336-4132
Fax Number	:	704-423-5775

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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