Provider Demographics
NPI:1356494074
Name:HURLEY, SUSAN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HURLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32790 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4075
Mailing Address - Country:US
Mailing Address - Phone:760-369-1743
Mailing Address - Fax:760-365-6934
Practice Address - Street 1:56299 29 PALMS HWY
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2857
Practice Address - Country:US
Practice Address - Phone:760-369-1743
Practice Address - Fax:760-365-6934
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 5196225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT0051960OtherBLUE SHIELD
CA72157585392277A004OtherTRICARE
CACT3786610Medicaid
CAZZZ19735ZMedicare PIN