Provider Demographics
NPI:1518576909
Name:SHAHSAVARI, SUSAN SHIREEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHIREEN
Last Name:SHAHSAVARI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:SHIREEN
Other - Last Name:SHAHSAVARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1140 W PIONEER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6383
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1140 W PIONEER PKWY STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6383
Practice Address - Country:US
Practice Address - Phone:469-587-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120672225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist