Provider Demographics
NPI:1891734976
Name:PARIS, SUSAN (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:PARIS
Suffix:
Gender:F
Credentials:OT
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:TWO MEDICAL PK
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3330
Practice Address - Country:US
Practice Address - Phone:251-665-8200
Practice Address - Fax:251-665-8210
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0163225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533606OtherBLUE CROSS
AL51557792Medicare ID - Type UnspecifiedRAILROAD PGBA