Provider Demographics
NPI:1376875153
Name:OLMSCHENK, SUSAN MAURINE (OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAURINE
Last Name:OLMSCHENK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 BLOSSOM TREE LN SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8993
Mailing Address - Country:US
Mailing Address - Phone:910-262-1331
Mailing Address - Fax:
Practice Address - Street 1:2585 HIGHWAY 179
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9451
Practice Address - Country:US
Practice Address - Phone:843-279-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2898225XP0200X
SC1419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301202Medicaid