Provider Demographics
NPI:1972750768
Name:ALDERSON, SUSAN RENEE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RENEE
Last Name:ALDERSON
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 1:1610 ONEAL RD.
Mailing Address - Street 2:
Mailing Address - City:ADOLPHUS
Mailing Address - State:KY
Mailing Address - Zip Code:42120
Mailing Address - Country:US
Mailing Address - Phone:270-622-7802
Mailing Address - Fax:
Practice Address - Street 1:550 HIGH ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1746
Practice Address - Country:US
Practice Address - Phone:270-843-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2198314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility