Provider Demographics
NPI:1225047673
Name:MITCHELL, SUSAN DIANE (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N PARKVIEW PL
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4442
Mailing Address - Country:US
Mailing Address - Phone:225-928-5383
Mailing Address - Fax:
Practice Address - Street 1:8032 SUMMA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3478
Practice Address - Country:US
Practice Address - Phone:225-769-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9310000148225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
W0T2216AMedicare ID - Type Unspecified