Provider Demographics
NPI:1215235684
Name:HALE, SUSAN B (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:HALE
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 1:1818 POT SPRING RD
Mailing Address - Street 2:STE. 30
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4445
Mailing Address - Country:US
Mailing Address - Phone:410-583-5765
Mailing Address - Fax:
Practice Address - Street 1:1818 POT SPRING RD
Practice Address - Street 2:STE. 30
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4445
Practice Address - Country:US
Practice Address - Phone:410-583-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist