Provider Demographics
NPI:1033275888
Name:GAMMON, SUSAN VICTORIA KATTULA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VICTORIA KATTULA
Last Name:GAMMON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:VICTORIA
Other - Last Name:KATTULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:6621 FANNIN ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-826-6121
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-826-6121
Practice Address - Fax:630-792-1801
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.0077182081P0010X
TX115581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine