Provider Demographics
NPI:1750826731
Name:POYER, SUSANNA
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:POYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:POYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:12 GREENVALE DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8765
Mailing Address - Country:US
Mailing Address - Phone:386-690-2485
Mailing Address - Fax:
Practice Address - Street 1:310 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7997
Practice Address - Country:US
Practice Address - Phone:910-521-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10618224Z00000X
FLOTA10339224Z00000X
WAOC60522546224Z00000X
TX212441224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant