Provider Demographics
NPI:1376661587
Name:PRIEST, SUSAN CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:PRIEST
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 1:3751 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5303
Mailing Address - Country:US
Mailing Address - Phone:970-581-4594
Mailing Address - Fax:
Practice Address - Street 1:2208 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5503
Practice Address - Country:US
Practice Address - Phone:970-581-4594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO801738Medicare ID - Type Unspecified