Provider Demographics
NPI:1336705243
Name:WILMETH, SUSAN MURDOCH (MSOT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MURDOCH
Last Name:WILMETH
Suffix:
Gender:F
Credentials:MSOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14708 CARRIAGE MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8338
Mailing Address - Country:US
Mailing Address - Phone:410-489-0079
Mailing Address - Fax:
Practice Address - Street 1:5086 DORSEY HALL DR STE 106
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7711
Practice Address - Country:US
Practice Address - Phone:410-997-0037
Practice Address - Fax:410-997-3510
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist