Provider Demographics
NPI:1124078084
Name:KAHN, EDITH SUZANNE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:SUZANNE
Last Name:KAHN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 BRACE LN
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9282
Mailing Address - Country:US
Mailing Address - Phone:919-960-7425
Mailing Address - Fax:
Practice Address - Street 1:3602 TRAIL TWENTY THREE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5156
Practice Address - Country:US
Practice Address - Phone:919-489-7771
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11274OtherBCBS
NC7301120Medicaid