Provider Demographics
NPI:1386645075
Name:OZAKI, SUSAN S (OTR L,CHT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:OZAKI
Suffix:
Gender:F
Credentials:OTR L,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S 900 E
Mailing Address - Street 2:#100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6657
Mailing Address - Country:US
Mailing Address - Phone:801-261-3321
Mailing Address - Fax:801-261-5942
Practice Address - Street 1:5151 S 900 E
Practice Address - Street 2:#100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6601
Practice Address - Country:US
Practice Address - Phone:801-261-3321
Practice Address - Fax:801-261-5942
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106559-42012251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1108540001OtherCIGNA DMERC
UT3603837001OtherCIGNA
UT5417OtherDMBA
UT88106559403001OtherBLUE CROSS BLUE SHIELD
UTQM000004843OtherALTIUS
UT870388269BR1OtherEDUCATORS MUTUAL
UT6400150OtherUNITED HEALTHCARE
UTCJ9402OtherRAILROAD MEDICARE
UT68951OtherPEHP
UT870388269BR1OtherEDUCATORS MUTUAL
UT5417OtherDMBA
UTP47545Medicare UPIN