Provider Demographics
NPI:1922329648
Name:WALKER, SUSAN M (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:PONZURIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 WOODACRE DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3505
Mailing Address - Country:US
Mailing Address - Phone:530-255-4063
Mailing Address - Fax:
Practice Address - Street 1:410 WOODACRE DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3505
Practice Address - Country:US
Practice Address - Phone:530-255-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5224225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5224OtherCALIFORNIA BOARD OF OCCUPATIONAL THERAPY LICENSE
1004228OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY