Provider Demographics
NPI:1942565163
Name:STERN, SUSAN F (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:STERN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CORPORATE DR
Mailing Address - Street 2:STE 301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-5424
Mailing Address - Country:US
Mailing Address - Phone:859-224-2271
Mailing Address - Fax:859-224-4675
Practice Address - Street 1:841 CORPORATE DR STE 301
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-5424
Practice Address - Country:US
Practice Address - Phone:859-333-9312
Practice Address - Fax:620-508-2008
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225XP0019X
KYR3536225XP0200X
KY135463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100223850Medicaid
KY7100223850Medicaid
KYK052610Medicare PIN