Provider Demographics
NPI:1295546695
Name:SOMERVILLE, SUE ELLEN (OTD, OTR/L, ATP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:OTD, OTR/L, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CHERYIL LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3306
Mailing Address - Country:US
Mailing Address - Phone:941-204-4996
Mailing Address - Fax:
Practice Address - Street 1:9837 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-5855
Practice Address - Country:US
Practice Address - Phone:251-517-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5073225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics