Provider Demographics
NPI:1386644805
Name:MAROLF, SUZANNE MARY (OTR/L CHT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:MAROLF
Suffix:
Gender:F
Credentials:OTR/L CHT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARY
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4157 S HARVARD AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2631
Mailing Address - Country:US
Mailing Address - Phone:918-712-7868
Mailing Address - Fax:918-749-2901
Practice Address - Street 1:4157 S HARVARD AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2631
Practice Address - Country:US
Practice Address - Phone:918-712-7868
Practice Address - Fax:918-749-2901
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT436225XH1200X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7864008OtherAETNA NON HMO
OK3765043OtherAETNA HMO