Provider Demographics
NPI:1164647343
Name:CHRISTIE, SUSAN H (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:HAUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1800 KENNEDY MOTT RD NW
Mailing Address - Street 2:
Mailing Address - City:DEPAUW
Mailing Address - State:IN
Mailing Address - Zip Code:47115-8017
Mailing Address - Country:US
Mailing Address - Phone:812-267-5541
Mailing Address - Fax:775-366-0529
Practice Address - Street 1:1800 KENNEDY MOTT RD NW
Practice Address - Street 2:
Practice Address - City:DEPAUW
Practice Address - State:IN
Practice Address - Zip Code:47115-8017
Practice Address - Country:US
Practice Address - Phone:812-267-5541
Practice Address - Fax:775-366-0529
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000664A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist