Provider Demographics
NPI:1174051288
Name:AVERITT, SUSAN LYNN (OTR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:AVERITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 COBBLEFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-9782
Mailing Address - Country:US
Mailing Address - Phone:317-501-7293
Mailing Address - Fax:
Practice Address - Street 1:9745 OLYMPIA DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9226
Practice Address - Country:US
Practice Address - Phone:877-931-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003250A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist