Provider Demographics
NPI:1134517873
Name:MEYER, SUSANNA ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ROSE
Last Name:MEYER
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 1:3801 SAN PABLO AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3879
Mailing Address - Country:US
Mailing Address - Phone:650-815-5496
Mailing Address - Fax:
Practice Address - Street 1:3030 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3411
Practice Address - Country:US
Practice Address - Phone:510-250-8014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13405225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist