Provider Demographics
NPI:1932156015
Name:LOUIE, SUSAN D (OTR L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:LOUIE
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 1:2820 GRIFFIN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:360-802-6838
Mailing Address - Fax:360-802-6839
Practice Address - Street 1:2820 GRIFFIN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-802-6838
Practice Address - Fax:360-802-6839
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002354225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4749320001OtherDMERC
WA7681992Medicaid
WA7681992Medicaid
WA8800440Medicare PIN
WA4749320001OtherDMERC