Provider Demographics
NPI:1316764210
Name:STARNS, SUZANNE MARIE (OT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:STARNS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 JOHNSTON CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:46167-9456
Mailing Address - Country:US
Mailing Address - Phone:317-459-1679
Mailing Address - Fax:
Practice Address - Street 1:22 JOHNSTON CT
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:IN
Practice Address - Zip Code:46167-9456
Practice Address - Country:US
Practice Address - Phone:317-459-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004184A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty