Provider Demographics
NPI:1558555151
Name:ZITKOVICH, SUSAN FAYE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FAYE
Last Name:ZITKOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CZARNOWSKI RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6251
Mailing Address - Country:US
Mailing Address - Phone:724-523-6395
Mailing Address - Fax:
Practice Address - Street 1:24 STOM RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-2001
Practice Address - Country:US
Practice Address - Phone:724-757-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC005371L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist