Provider Demographics
NPI:1619183100
Name:MASON, SUSAN DENISE (OT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:DENISE
Last Name:MASON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 THOROUGHBRED LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4225
Mailing Address - Country:US
Mailing Address - Phone:615-415-0396
Mailing Address - Fax:
Practice Address - Street 1:5054 THOROUGHBRED LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4225
Practice Address - Country:US
Practice Address - Phone:615-415-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT2065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNOT2065OtherTN OCCUPATIONAL THERAPY L