Provider Demographics
NPI:1679061808
Name:GROGAN, SUSAN SWYERS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:SWYERS
Last Name:GROGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 FLAMEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-339-7430
Mailing Address - Fax:314-449-9173
Practice Address - Street 1:2806 FLAMEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129
Practice Address - Country:US
Practice Address - Phone:314-339-7430
Practice Address - Fax:314-449-9173
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000578225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology