Provider Demographics
NPI:1841488566
Name:ADLER, SUSAN (ITDS;MA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:ADLER
Suffix:
Gender:F
Credentials:ITDS;MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3695 WOODS WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2357
Mailing Address - Country:US
Mailing Address - Phone:561-434-5459
Mailing Address - Fax:
Practice Address - Street 1:3695 WOODS WALK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2357
Practice Address - Country:US
Practice Address - Phone:561-434-5459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist