Provider Demographics
NPI:1770026007
Name:ROSSI, SUSAN L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:ROSSI
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-0244
Mailing Address - Country:US
Mailing Address - Phone:785-871-1591
Mailing Address - Fax:
Practice Address - Street 1:113 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2046
Practice Address - Country:US
Practice Address - Phone:785-871-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-00519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist