Provider Demographics
NPI:1467681650
Name:PHILLIPS, SUSAN L (COTA/L, LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:COTA/L, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4438 WITHROWWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5506
Mailing Address - Country:US
Mailing Address - Phone:407-952-1103
Mailing Address - Fax:
Practice Address - Street 1:4438 WITHROWWOOD CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5506
Practice Address - Country:US
Practice Address - Phone:407-952-1103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 13596224Z00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant