Provider Demographics
NPI:1477725265
Name:HOSSACK, SUE (MOT, OTR/L, ATP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HOSSACK
Suffix:
Gender:F
Credentials:MOT, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8678
Mailing Address - Country:US
Mailing Address - Phone:540-320-8454
Mailing Address - Fax:540-301-6372
Practice Address - Street 1:3261 GORDON DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8678
Practice Address - Country:US
Practice Address - Phone:540-320-8454
Practice Address - Fax:540-301-6372
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003829225X00000X
RESNA225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner