Provider Demographics
NPI:1669678850
Name:GOERKE, SUSAN CAROL (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:GOERKE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11906 CHEVIOTT HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3898
Mailing Address - Country:US
Mailing Address - Phone:704-454-7768
Mailing Address - Fax:
Practice Address - Street 1:11906 CHEVIOTT HILL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3898
Practice Address - Country:US
Practice Address - Phone:704-454-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5298225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics