Provider Demographics
NPI:1427019595
Name:WINDUS, SUZANNE (MS, OT, CHT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:WINDUS
Suffix:
Gender:F
Credentials:MS, OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 MAPLEWOOD AVE
Mailing Address - Street 2:UNIT 16
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-2533
Mailing Address - Country:US
Mailing Address - Phone:215-287-0639
Mailing Address - Fax:
Practice Address - Street 1:6801 PARK TER
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1543
Practice Address - Country:US
Practice Address - Phone:310-665-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00311200225XH1200X
PAOC005360L225XH1200X
CAOT 11876225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand