Provider Demographics
NPI:1508975483
Name:DODDRIDGE, SUZANNE E (OTRL)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:DODDRIDGE
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 1:18 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-253-7521
Mailing Address - Fax:828-251-5992
Practice Address - Street 1:18 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-253-7521
Practice Address - Fax:828-251-5992
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4102225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7302035Medicaid
2511548Medicare PIN
2511548AMedicare PIN