Provider Demographics
NPI:1578896106
Name:WOODS, SUE-ANN R (OTR)
Entity Type:Individual
Prefix:
First Name:SUE-ANN
Middle Name:R
Last Name:WOODS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUE-ANN
Other - Middle Name:
Other - Last Name:MULDREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:625 LINCOLN AVE.
Mailing Address - Street 2:
Mailing Address - City:N. CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022
Mailing Address - Country:US
Mailing Address - Phone:724-483-3610
Mailing Address - Fax:724-489-4758
Practice Address - Street 1:160 GREENE PLAZA
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-852-2504
Practice Address - Fax:724-852-2547
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252906225X00000X
PAOC011100225X00000X
PA225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102385267Medicaid
PA166890ZDQZMedicare PIN