Provider Demographics
NPI:1497873921
Name:MESS, SUSAN (OTRL)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MESS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 PAN AMERICAN FWY NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4792
Mailing Address - Country:US
Mailing Address - Phone:505-888-4469
Mailing Address - Fax:505-889-8142
Practice Address - Street 1:3530 PAN AMERICAN FWY NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4792
Practice Address - Country:US
Practice Address - Phone:505-888-4469
Practice Address - Fax:505-889-8142
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist