Provider Demographics
NPI:1568529949
Name:STROUP, SUSAN HANNULA (ATC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HANNULA
Last Name:STROUP
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TURNERS CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1710
Mailing Address - Country:US
Mailing Address - Phone:252-728-3514
Mailing Address - Fax:252-728-3487
Practice Address - Street 1:3263 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-7897
Practice Address - Country:US
Practice Address - Phone:252-728-3514
Practice Address - Fax:252-728-3487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist