Provider Demographics
NPI:1629306360
Name:CHEFER, SUSAN C
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:CHEFER
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 1:2868 EVERCHARM PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5865
Mailing Address - Country:US
Mailing Address - Phone:904-880-5792
Mailing Address - Fax:
Practice Address - Street 1:4077 N CHINOOK LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9326
Practice Address - Country:US
Practice Address - Phone:386-793-8120
Practice Address - Fax:386-672-3929
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist