Provider Demographics
NPI:1427125673
Name:FOSTER, SUE ELLEN (OTRL, M ED)
Entity type:Individual
Prefix:
First Name:SUE ELLEN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OTRL, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4927
Mailing Address - Country:US
Mailing Address - Phone:814-946-5411
Mailing Address - Fax:
Practice Address - Street 1:201 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4927
Practice Address - Country:US
Practice Address - Phone:814-944-8177
Practice Address - Fax:814-944-7413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001607L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7268635OtherAETNA
PA0017610720005Medicaid
PA1779331OtherHIGHMARK
PA248971OtherHEALTH AMERICA