Provider Demographics
NPI:1427348622
Name:OLANDER, SUSAN KAY (COTA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KAY
Last Name:OLANDER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8777 TULARE DR UNIT 408A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-6288
Mailing Address - Country:US
Mailing Address - Phone:714-274-9381
Mailing Address - Fax:
Practice Address - Street 1:8777 TULARE DR UNIT 408A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-6288
Practice Address - Country:US
Practice Address - Phone:714-274-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225ZOOOOOXMedicaid