Susan Ashley Durham, C.O.T.A
Individual provider Active NPI Occupational Therapy Assistant · Kimberling City, MO
NPI 1154587699 · NPPES record last updated Aug 4, 2008
Key facts
- NPI
- 1154587699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 2005023369 (MO)
- Practice address
- 276 Fountain LN
Kimberling City, MO 65686-9356 - Phone
- (417) 739-2481
- NPI assigned
- Aug 4, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2005023369 | MO | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 2005023369 | MO | Yes |
Addresses
Primary practice location
276 Fountain LN
Kimberling City, MO 65686-9356
Mailing address
213 Micahs Xing
Reeds Spring, MO 65737-9787
Phone (417) 272-0393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2005023369 | Other | MO | STATE LICENSURE NUMBER FOR OCCUPATIONAL THERAPY ASSISTANT |
Other providers in Kimberling City, MO
- Sharon Rae Bruffett
- Theodore Steve Caddell
- Charest Chiropractic
- Bruce Aaron Charest
- Fordland Clinic, Inc.
- Daniel E Kessler
- Kimberling City Pharmacy, Inc.
- Kimberling Vision Center, Inc
- Douglas Lee Kolb
All providers in Kimberling City, MO · Occupational Therapy Assistant in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.