Provider Demographics
NPI:1063639953
Name:STERN, SUSAN DIANE (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:STERN
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 1:3103 SAINT FLORENCE TER
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1619
Mailing Address - Country:US
Mailing Address - Phone:301-570-0348
Mailing Address - Fax:
Practice Address - Street 1:7300 GOLDEN FERN CT
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5946
Practice Address - Country:US
Practice Address - Phone:410-796-8499
Practice Address - Fax:443-270-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03889225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics