Provider Demographics
NPI:1851503015
Name:STEELE, R. SUSAN (MOT, OTR)
Entity Type:Individual
Prefix:
First Name:R. SUSAN
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7452
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-0452
Mailing Address - Country:US
Mailing Address - Phone:817-923-6981
Mailing Address - Fax:817-923-6981
Practice Address - Street 1:1550 W ROSEDALE ST
Practice Address - Street 2:SUITE 522
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7438
Practice Address - Country:US
Practice Address - Phone:817-877-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102792225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102792OtherOT LICENSE, STATE BOARD