Provider Demographics
NPI:1013020361
Name:DETAR, SUSAN MARGARET (CFM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARGARET
Last Name:DETAR
Suffix:
Gender:F
Credentials:CFM
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Other - Credentials:
Mailing Address - Street 1:101 SUNSET PT
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-9018
Mailing Address - Country:US
Mailing Address - Phone:386-328-9424
Mailing Address - Fax:386-328-9470
Practice Address - Street 1:101 SUNSET PT
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-9018
Practice Address - Country:US
Practice Address - Phone:386-328-9424
Practice Address - Fax:386-328-9470
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management