Provider Demographics
NPI:1447595673
Name:CAVENDER, SUSAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 WEAVER SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:MO
Mailing Address - Zip Code:64076-6289
Mailing Address - Country:US
Mailing Address - Phone:816-633-4663
Mailing Address - Fax:
Practice Address - Street 1:503 REGENT DRIVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-0000
Practice Address - Country:US
Practice Address - Phone:660-429-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035701224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant