Provider Demographics
NPI:1164646584
Name:DARR, SUSAN RUTH (OTL)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RUTH
Last Name:DARR
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-8318
Mailing Address - Country:US
Mailing Address - Phone:907-299-3120
Mailing Address - Fax:
Practice Address - Street 1:925 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-8318
Practice Address - Country:US
Practice Address - Phone:907-299-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist