Provider Demographics
NPI:1063963304
Name:TRAUT, SUSAN (COTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TRAUT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DUNLAP CIR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-5206
Mailing Address - Country:US
Mailing Address - Phone:810-417-1667
Mailing Address - Fax:
Practice Address - Street 1:1 DUNLAP CIR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-5206
Practice Address - Country:US
Practice Address - Phone:810-417-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213858313M00000X
MI5202007360313M00000X
CAOTA3577314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility