Provider Demographics
NPI:1023126968
Name:DURHAM, SUSAN W (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:W
Last Name:DURHAM
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 1:211 SUMMERTIME BAY
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-9304
Mailing Address - Country:US
Mailing Address - Phone:501-525-1234
Mailing Address - Fax:
Practice Address - Street 1:1401 MALVERN AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6327
Practice Address - Country:US
Practice Address - Phone:501-624-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist