Provider Demographics
NPI:1952679656
Name:WIMMER, SUE ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ANN
Last Name:WIMMER
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 1:3878 BEVERLY AVE NE
Mailing Address - Street 2:BLDG H SUITE 11
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1394
Mailing Address - Country:US
Mailing Address - Phone:503-576-4528
Mailing Address - Fax:
Practice Address - Street 1:3878 BEVERLY AVE NE
Practice Address - Street 2:BLDG H SUITE 11
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1394
Practice Address - Country:US
Practice Address - Phone:503-576-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR418863225XP0200X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics