Provider Demographics
NPI:1376852962
Name:HEARNE, SUSAN ARLEY (CTRS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ARLEY
Last Name:HEARNE
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 BERWYCK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3282
Mailing Address - Country:US
Mailing Address - Phone:248-840-5870
Mailing Address - Fax:
Practice Address - Street 1:5482 BERWYCK DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3282
Practice Address - Country:US
Practice Address - Phone:248-840-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
56518225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist