Individual provider Active NPI

Susan L Fetter, OTR

  • Occupational Therapist
  • Tempe, AZ
National Provider Identifier
1003960857
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
2466 Issued in AZ
Practice address
215 W Lodge Dr
Tempe, AZ 85283-3652
Phone
(480) 730-4103
Fax
(480) 897-0014
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 2466 AZ Primary

Addresses

Primary practice location

215 W Lodge Dr
Tempe, AZ 85283-3652

Mailing address

4145 N 42ND St
Phoenix, AZ 85018-4206
Phone (480) 980-8734

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2466AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Centers for Habilitation Past Accepting new patients
Pioneer Pet, LLC Past Accepting new patients
Solace Pediatric Healthcare Therapy Services Az, Inc. Occupational Therapist PastSince Jan 1, 1995 Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003960857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4145 N 42ND ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850184206",
            "telephone_number": "480-980-8734",
            "fax_number": "480-897-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W LODGE DR",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852833652",
            "telephone_number": "480-730-4103",
            "fax_number": "480-897-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTER",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AZ",
            "license": "2466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.