Provider Demographics
NPI:1679583348
Name:SLAUGHTER, SUSAN KLEMM (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KLEMM
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:KLEMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:525 QUEENS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1423
Mailing Address - Country:US
Mailing Address - Phone:704-366-4132
Mailing Address - Fax:704-423-5775
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:SUITE 212
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1032
Practice Address - Country:US
Practice Address - Phone:704-336-4132
Practice Address - Fax:704-423-5775
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2924225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC731061HMedicaid