Provider Demographics
NPI:1174928451
Name:SUSAN FICKEN PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:SUSAN FICKEN PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:FICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-656-6071
Mailing Address - Street 1:132 DON DR
Mailing Address - Street 2:
Mailing Address - City:SHOHOLA
Mailing Address - State:PA
Mailing Address - Zip Code:18458-4147
Mailing Address - Country:US
Mailing Address - Phone:570-656-6071
Mailing Address - Fax:
Practice Address - Street 1:132 DON DR
Practice Address - Street 2:
Practice Address - City:SHOHOLA
Practice Address - State:PA
Practice Address - Zip Code:18458-4147
Practice Address - Country:US
Practice Address - Phone:570-656-6071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty