Provider Demographics
NPI:1063755056
Name:LLOYD, SUSANNA M (CO CFOM)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:M
Last Name:LLOYD
Suffix:
Gender:F
Credentials:CO CFOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-8614
Mailing Address - Country:US
Mailing Address - Phone:405-310-3344
Mailing Address - Fax:405-310-3340
Practice Address - Street 1:1018 24TH AVE NW
Practice Address - Street 2:SUITE 110
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6543
Practice Address - Country:US
Practice Address - Phone:405-310-3344
Practice Address - Fax:405-310-3340
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier