Provider Demographics
NPI:1477112019
Name:CASPER, SUZANNE ELIZABETH (OTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:CASPER
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWANQUARTER
Mailing Address - State:NC
Mailing Address - Zip Code:27885-9372
Mailing Address - Country:US
Mailing Address - Phone:252-926-9919
Mailing Address - Fax:252-926-2414
Practice Address - Street 1:1719 QUARTER RD
Practice Address - Street 2:
Practice Address - City:SWANQUARTER
Practice Address - State:NC
Practice Address - Zip Code:27885-9616
Practice Address - Country:US
Practice Address - Phone:252-926-2143
Practice Address - Fax:252-926-2414
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6384224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant