Provider Demographics
NPI:1366747529
Name:SURMAN, PATRICIA ANN (OT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SURMAN
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 1:570 N WHITMAN CT SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-7710
Mailing Address - Country:US
Mailing Address - Phone:616-826-5668
Mailing Address - Fax:
Practice Address - Street 1:128 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1629
Practice Address - Country:US
Practice Address - Phone:616-772-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003353225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist