Provider Demographics
NPI:1336264571
Name:WILKINSON, SUSAN C (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LEE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4043
Mailing Address - Country:US
Mailing Address - Phone:410-507-9622
Mailing Address - Fax:
Practice Address - Street 1:1454 FAIRFIELD LOOP RD
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2006
Practice Address - Country:US
Practice Address - Phone:410-923-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04717225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1299OtherOCCUPATIONAL THERAPIST