Provider Demographics
NPI:1194022855
Name:WIEMERS, SUSAN HEATHER (OTR)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HEATHER
Last Name:WIEMERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 HUNTINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6864
Mailing Address - Country:US
Mailing Address - Phone:620-481-8552
Mailing Address - Fax:
Practice Address - Street 1:1217 S 15TH ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-5125
Practice Address - Country:US
Practice Address - Phone:620-421-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17-01688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist