Provider Demographics
NPI:1114298353
Name:MCCALLUM WINTERS, SUSAN M (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MCCALLUM WINTERS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:PO BOX 776087
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-6087
Mailing Address - Country:US
Mailing Address - Phone:970-846-5202
Mailing Address - Fax:970-300-3112
Practice Address - Street 1:941 LINCOLN AVE SUITE 200 C
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-3062
Practice Address - Country:US
Practice Address - Phone:970-879-6556
Practice Address - Fax:970-300-3112
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA56460OtherNBCOT
CO973OtherOTR/L
1041100575OtherHAND THERAPY CERTIFICATION COMMITTEE