Provider Demographics
NPI:1467623017
Name:HORN, SUSAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MAR JANE AVE
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7655
Mailing Address - Country:US
Mailing Address - Phone:801-231-9207
Mailing Address - Fax:801-290-2866
Practice Address - Street 1:872 MAR JANE AVE
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7655
Practice Address - Country:US
Practice Address - Phone:801-231-9207
Practice Address - Fax:801-290-2866
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5629747-4201172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker