Provider Demographics
NPI:1114258688
Name:POPEK-BOEVE, SUSAN LYNNE (CTRS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LYNNE
Last Name:POPEK-BOEVE
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 CANNELLE CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4587
Mailing Address - Country:US
Mailing Address - Phone:734-262-4786
Mailing Address - Fax:
Practice Address - Street 1:143 CANNELLE CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4587
Practice Address - Country:US
Practice Address - Phone:734-262-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23270225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist