Provider Demographics
NPI:1093085581
Name:ALEXANDER, SUSAN GAMBILL
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAMBILL
Last Name:ALEXANDER
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 1:5667 CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-8102
Mailing Address - Country:US
Mailing Address - Phone:719-282-8656
Mailing Address - Fax:
Practice Address - Street 1:5667 CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-8102
Practice Address - Country:US
Practice Address - Phone:719-282-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4386225X00000X
CO1542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist