Provider Demographics
NPI:1083967293
Name:YANCEY, SUSAN BURTS
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BURTS
Last Name:YANCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:SULLIVAN
Other - Last Name:BURTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 CEDAR CT STE 120
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1494
Mailing Address - Country:US
Mailing Address - Phone:803-315-3044
Mailing Address - Fax:
Practice Address - Street 1:57 CEDAR CT
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1494
Practice Address - Country:US
Practice Address - Phone:803-315-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP009883224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty