Provider Demographics
NPI:1851541775
Name:STEVENS, SUSAN KEETON (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KEETON
Last Name:STEVENS
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 1:394 GUYMARD TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7109
Mailing Address - Country:US
Mailing Address - Phone:845-649-5888
Mailing Address - Fax:845-386-4892
Practice Address - Street 1:394 GUYMARD TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7109
Practice Address - Country:US
Practice Address - Phone:845-649-5888
Practice Address - Fax:845-386-4892
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-28
Last Update Date:2008-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005497-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist