Provider Demographics
NPI:1831301696
Name:HODGES, SUSAN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HODGES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 E RAY RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4707
Mailing Address - Country:US
Mailing Address - Phone:480-704-5954
Mailing Address - Fax:317-823-6327
Practice Address - Street 1:1332 E HIDDENVIEW DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8674
Practice Address - Country:US
Practice Address - Phone:317-670-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000682A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist