Provider Demographics
NPI:1457348633
Name:FREED, SUSAN ANNE (MOT, OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:FREED
Suffix:
Gender:F
Credentials:MOT, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2044
Mailing Address - Street 2:
Mailing Address - City:IDYLLWILD
Mailing Address - State:CA
Mailing Address - Zip Code:92549-2044
Mailing Address - Country:US
Mailing Address - Phone:951-468-4227
Mailing Address - Fax:
Practice Address - Street 1:25370 FERNLEAF DR
Practice Address - Street 2:
Practice Address - City:IDYLLWILD
Practice Address - State:CA
Practice Address - Zip Code:92549
Practice Address - Country:US
Practice Address - Phone:951-468-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11522225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457348633Medicare PIN