Provider Demographics
NPI:1275727612
Name:BRITT, SUSAN D (COF, CFM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:BRITT
Suffix:
Gender:F
Credentials:COF, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 S SCALES ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5330
Mailing Address - Country:US
Mailing Address - Phone:336-342-6474
Mailing Address - Fax:336-342-7660
Practice Address - Street 1:726 S SCALES ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5330
Practice Address - Country:US
Practice Address - Phone:336-342-6474
Practice Address - Fax:336-342-7660
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740278167OtherNPI
NC7795124Medicaid
NC7795235Medicaid