Active NPI
Susan Smicklas Wadsworth, OT
- Occupational Therapist
- Ponte Vedra Beach, FL
National Provider Identifier
1518399476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT8659
- Practice address
- 1002 Marsh Cove CT
Ponte Vedra Beach, FL 32082-1645 - Phone
- (904) 962-1299
- NPI assigned
- Aug 2, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT8659 | FL | Primary |
Addresses
Primary practice location
1002 Marsh Cove CT
Ponte Vedra Beach, FL 32082-1645
Mailing address
1002 Marsh Cove CT
Ponte Vedra Beach, FL 32082-1645
Phone (904) 962-1299
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
| License | State | Type | Specialty |
|---|---|---|---|
| OT8659 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375401600000",
"number": "1518399476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1002 MARSH COVE CT",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320821645",
"telephone_number": "904-962-1299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1002 MARSH COVE CT",
"city": "PONTE VEDRA BEACH",
"state": "FL",
"postal_code": "320821645",
"telephone_number": "904-962-1299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADSWORTH",
"first_name": "SUSAN",
"middle_name": "SMICKLAS",
"name_prefix": "Mrs.",
"credential": "OT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-02",
"last_updated": "2013-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "OT8659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponte Vedra Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.