Provider Demographics
NPI:1891812160
Name:FRITZ, SUSAN M (OT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:FRITZ
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 1:23563 WASHINGTON ST NE
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3111 124TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-1793
Practice Address - Country:US
Practice Address - Phone:763-236-8911
Practice Address - Fax:763-236-8930
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101232225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist