Provider Demographics
NPI:1942544564
Name:BAUER, SUSAN L (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BALLY
Mailing Address - State:PA
Mailing Address - Zip Code:19503-9662
Mailing Address - Country:US
Mailing Address - Phone:610-845-7121
Mailing Address - Fax:
Practice Address - Street 1:243 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BALLY
Practice Address - State:PA
Practice Address - Zip Code:19503-9662
Practice Address - Country:US
Practice Address - Phone:610-845-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP000035L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant