Provider Demographics
NPI:1174099352
Name:EVANS, SUSAN BETH (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-758-7720
Mailing Address - Fax:248-758-7722
Practice Address - Street 1:320 TOWN CENTER BLVD STE C-101
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-2183
Practice Address - Country:US
Practice Address - Phone:248-758-7790
Practice Address - Fax:248-758-7795
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist