Provider Demographics
NPI:1982865184
Name:PATOUT, SUSAN LESLIE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LESLIE
Last Name:PATOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4718 HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-3909
Mailing Address - Country:US
Mailing Address - Phone:713-622-2929
Mailing Address - Fax:
Practice Address - Street 1:4718 HALLMARK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-3909
Practice Address - Country:US
Practice Address - Phone:713-622-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111891225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W860Medicare PIN