Provider Demographics
NPI:1629242193
Name:EDWARDS, SUSAN ANNE JULIAN (OTR, CHT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE JULIAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ANNE
Other - Last Name:JULIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, CHT
Mailing Address - Street 1:PO BOX 847556
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-2111
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109972225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist