Provider Demographics
NPI:1366565715
Name:HUNDSDORFER, SUSAN ZEKERT (OTR, CLVT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ZEKERT
Last Name:HUNDSDORFER
Suffix:
Gender:F
Credentials:OTR, CLVT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ZEKERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR, CLVT
Mailing Address - Street 1:610 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5905
Mailing Address - Country:US
Mailing Address - Phone:303-543-0669
Mailing Address - Fax:303-494-0530
Practice Address - Street 1:610 S 40TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5905
Practice Address - Country:US
Practice Address - Phone:303-543-0669
Practice Address - Fax:303-494-0530
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO HAS NO OT LICENSE225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15297957OtherWITHHOLD LIC-EYEONLIVING
CO665829002001OtherUNEMP INS TAXIDEYEONLIVIN
CO63180855Medicaid
969623OtherNATL BOARD FOR CERT IN OT
969623OtherNATL BOARD FOR CERT IN OT
CO63180855Medicaid
969623OtherNATL BOARD FOR CERT IN OT
C24953Medicare ID - Type UnspecifiedPROVIDER NUMBER