Provider Demographics
NPI:1740338748
Name:GEDNEY, SUSAN JEAN (BS,OTRL)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:GEDNEY
Suffix:
Gender:F
Credentials:BS,OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WOODETTE DR
Mailing Address - Street 2:APT E-105
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-8700
Mailing Address - Country:US
Mailing Address - Phone:315-576-4523
Mailing Address - Fax:
Practice Address - Street 1:300 WOODETTE DR
Practice Address - Street 2:APT E-105
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-8700
Practice Address - Country:US
Practice Address - Phone:315-576-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12230225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ131AOtherBCBS