Provider Demographics
NPI:1316268394
Name:COURT, SUSAN M (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:COURT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PORT ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-7003
Mailing Address - Country:US
Mailing Address - Phone:772-913-4133
Mailing Address - Fax:
Practice Address - Street 1:117 PORT ROYAL CT
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-7003
Practice Address - Country:US
Practice Address - Phone:772-913-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6595225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889770100Medicaid