Provider Demographics
NPI:1376018945
Name:PATE, SUSANNAH (OT)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:PATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:1400 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5647
Mailing Address - Country:US
Mailing Address - Phone:844-245-2720
Mailing Address - Fax:
Practice Address - Street 1:515 WARLEY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5132
Practice Address - Country:US
Practice Address - Phone:843-245-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4804225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherPRIVATE PAY