Provider Demographics
NPI:1104381193
Name:WEST, SUSAN JOSEPHINE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOSEPHINE
Last Name:WEST
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 FOLIAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1009
Mailing Address - Country:US
Mailing Address - Phone:936-718-9746
Mailing Address - Fax:
Practice Address - Street 1:23775 KINGWOOD PLACE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3817
Practice Address - Country:US
Practice Address - Phone:936-718-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214196224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant