Individual provider Active NPI

Susan Beth Evans, OTRL

  • Occupational Therapist
  • White Lake, MI
National Provider Identifier
1174099352
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
320 Town Center Blvd Ste C-101
White Lake, MI 48386-2183
Phone
(248) 758-7790
Fax
(248) 758-7795
NPI assigned
Oct 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

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 Primary

Addresses

Primary practice location

320 Town Center Blvd Ste C-101
White Lake, MI 48386-2183

Mailing address

44405 Woodward Ave
Pontiac, MI 48341-5023
Phone (248) 758-7720

Other practice location 1

44428 Woodward Ave Ste 105
Pontiac, MI 48341-5009
Phone (248) 758-7720

Other practice location 2

44405 Woodward Ave
Pontiac, MI 48341-5023
Phone (248) 858-6000

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

NPI Registry JSON

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

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539648000000",
    "number": "1174099352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44405 WOODWARD AVE",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415023",
            "telephone_number": "248-758-7720",
            "fax_number": "248-758-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 TOWN CENTER BLVD STE C-101",
            "city": "WHITE LAKE",
            "state": "MI",
            "postal_code": "483862183",
            "telephone_number": "248-758-7790",
            "fax_number": "248-758-7795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44428 Woodward Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483415009",
            "country_code": "US",
            "telephone_number": "248-758-7720",
            "fax_number": "248-758-7722",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "44405 Woodward Ave",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "MI",
            "postal_code": "483415023",
            "country_code": "US",
            "telephone_number": "248-858-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EVANS",
        "first_name": "SUSAN",
        "middle_name": "BETH",
        "name_prefix": "Mrs.",
        "credential": "OTRL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2018-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; 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.