Provider Demographics
NPI:1700275864
Name:PADGETT, SUSAN C (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:C
Last Name:PADGETT
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 1:321 MOUNT MORIAH RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6944
Mailing Address - Country:US
Mailing Address - Phone:270-898-6286
Mailing Address - Fax:
Practice Address - Street 1:321 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-6944
Practice Address - Country:US
Practice Address - Phone:270-556-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0983225X00000X
IL056-003651225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist