Provider Demographics
NPI:1003039660
Name:CHACON, SUSANA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:CHACON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3632
Mailing Address - Country:US
Mailing Address - Phone:706-825-2996
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:516 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3632
Practice Address - Country:US
Practice Address - Phone:706-825-2996
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist