Provider Demographics
NPI:1689732539
Name:JONES, SUSAN LATSHAW (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LATSHAW
Last Name:JONES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARGARET
Other - Last Name:LATSHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:163 SCHOOL ST APT C
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901
Mailing Address - Country:US
Mailing Address - Phone:205-356-2629
Mailing Address - Fax:
Practice Address - Street 1:959 CONGRESS ST, SUITE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2715
Practice Address - Country:US
Practice Address - Phone:207-699-5600
Practice Address - Fax:207-699-5588
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2495225X00000X
MEOT4376225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2495OtherOT LICENSE