Provider Demographics
NPI:1093848087
Name:MARKLE, SUSAN MARY (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:MARKLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARY
Other - Last Name:LEIDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 KNOLLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3830
Mailing Address - Country:US
Mailing Address - Phone:770-960-9961
Mailing Address - Fax:770-960-9662
Practice Address - Street 1:7146 SOUTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3075
Practice Address - Country:US
Practice Address - Phone:770-960-9961
Practice Address - Fax:770-960-9662
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000272225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics