Provider Demographics
NPI:1205043502
Name:FEFFERMAN, SUZANNE MARIE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:FEFFERMAN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:WROBLEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 SW 38TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7005
Mailing Address - Country:US
Mailing Address - Phone:580-353-1490
Mailing Address - Fax:580-250-1651
Practice Address - Street 1:916 SW 38TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7005
Practice Address - Country:US
Practice Address - Phone:580-353-1490
Practice Address - Fax:580-250-1651
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014105225X00000X
GAOT005049225X00000X
OK1719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist