Provider Demographics
NPI:1952881104
Name:GILLESPIE, SUSAN PEAK (OTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PEAK
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 METRIC BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-8616
Mailing Address - Country:US
Mailing Address - Phone:512-228-3300
Mailing Address - Fax:
Practice Address - Street 1:12021 METRIC BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-8616
Practice Address - Country:US
Practice Address - Phone:512-228-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant