Susan D Lee, COTA

Individual provider Active NPI Occupational Therapy Assistant · Gwinner, ND

NPI 1073663415 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1073663415
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
587 (ND)
Practice address
11 North Main Street
Gwinner, ND 58040-0586
Phone
(701) 678-2244
Fax
(701) 678-2210
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
No

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
587NDMDPhysical Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 587 ND Yes

Addresses

Primary practice location

11 North Main Street
Gwinner, ND 58040-0586

Mailing address

PO Box 586
11 North Main Street
Gwinner, ND 58040-0586
Phone (701) 678-2244

Other names

  • Susan D Degrand Former name

Other providers in Gwinner, ND

All providers in Gwinner, ND · Occupational Therapy Assistant in North Dakota

Sources for this page

Verify at the official NPI Registry.