Provider Demographics
NPI:1205091808
Name:BIXBY, SUSAN CAROL (BS OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAROL
Last Name:BIXBY
Suffix:
Gender:F
Credentials:BS OTR/L
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS OTR/L
Mailing Address - Street 1:15 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9310
Mailing Address - Country:US
Mailing Address - Phone:585-703-7367
Mailing Address - Fax:585-335-6813
Practice Address - Street 1:311 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9798
Practice Address - Country:US
Practice Address - Phone:585-335-6770
Practice Address - Fax:585-335-6813
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005427-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist