Provider Demographics
NPI:1114148350
Name:DENHAM, SUSAN (OTR, CHT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:DENHAM
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 TECHNACENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6028
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:7057 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6927
Practice Address - Country:US
Practice Address - Phone:334-625-5809
Practice Address - Fax:334-271-2555
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0181225X00000X
AL1021100145225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12476820OtherCAQH
AL511-46590OtherBCBS OF AL
AL12476820OtherCAQH
AL102I676844Medicare PIN