Provider Demographics
NPI:1013774769
Name:TIECHE, SUSAN R (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:TIECHE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LINDEN LN STE 110
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1265
Mailing Address - Country:US
Mailing Address - Phone:240-462-1444
Mailing Address - Fax:
Practice Address - Street 1:2900 LINDEN LN STE 110
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1265
Practice Address - Country:US
Practice Address - Phone:240-462-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist