Provider Demographics
NPI:1417759515
Name:ROBERTS, SUSAN ELLEN (ATR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:ROBERTS
Suffix:
Gender:
Credentials:ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2182 NEW RIVER INLET RD UNIT 280
Mailing Address - Street 2:
Mailing Address - City:N TOPSAIL BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28460-9315
Mailing Address - Country:US
Mailing Address - Phone:919-482-4620
Mailing Address - Fax:
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-449-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
07-115221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist