Provider Demographics
NPI:1184724775
Name:THORNTON, SUSAN G (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:THORNTON
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 1:1125 CAMBRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2946
Mailing Address - Country:US
Mailing Address - Phone:864-941-5563
Mailing Address - Fax:864-941-5536
Practice Address - Street 1:1125 CAMBRIDGE AVE E
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2946
Practice Address - Country:US
Practice Address - Phone:864-941-5563
Practice Address - Fax:864-941-5536
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0268Medicaid