Provider Demographics
NPI:1336563972
Name:COLBORN, SUSAN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:COLBORN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3805 MARLANE DRIVE
Mailing Address - Street 2:SOUTH WESTERN CITY SCHOOLS
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123
Mailing Address - Country:US
Mailing Address - Phone:614-801-3000
Mailing Address - Fax:614-871-2781
Practice Address - Street 1:4324 HAUGHN ROAD
Practice Address - Street 2:SOUTH WESTERN EDUCATION PRESCHOOL CENTER - TUESDAY & WE
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123
Practice Address - Country:US
Practice Address - Phone:614-801-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.002139225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist