Provider Demographics
NPI:1073846572
Name:ATKINS, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 W GREEN OAKS BLVD
Mailing Address - Street 2:3305-159
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4462
Mailing Address - Country:US
Mailing Address - Phone:817-689-2157
Mailing Address - Fax:
Practice Address - Street 1:4101 W GREEN OAKS BLVD
Practice Address - Street 2:3305-159
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4462
Practice Address - Country:US
Practice Address - Phone:817-689-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102154225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist