Provider Demographics
NPI:1114205259
Name:HOULE, SUSAN BELLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BELLE
Last Name:HOULE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DILLON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3546
Mailing Address - Country:US
Mailing Address - Phone:575-445-2418
Mailing Address - Fax:575-445-0112
Practice Address - Street 1:160 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-2002
Practice Address - Country:US
Practice Address - Phone:575-445-0111
Practice Address - Fax:575-445-0112
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2599225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist