Provider Demographics
NPI:1952744088
Name:MORTIMER-CRAWFORD, SUZANNE (OT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MORTIMER-CRAWFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2361 AMBERLY PL
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2511
Mailing Address - Country:US
Mailing Address - Phone:805-641-6424
Mailing Address - Fax:805-641-6415
Practice Address - Street 1:3525 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3101
Practice Address - Country:US
Practice Address - Phone:805-641-6424
Practice Address - Fax:805-641-6415
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT4901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT4901OtherOT LICENSE
CAOT4901OtherOT LICENSE