Provider Demographics
NPI:1588782817
Name:DUBUQUE, SUSAN ANGELA (OT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANGELA
Last Name:DUBUQUE
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 1:139 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5624
Mailing Address - Country:US
Mailing Address - Phone:410-392-2731
Mailing Address - Fax:410-392-2732
Practice Address - Street 1:139 E HIGH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5624
Practice Address - Country:US
Practice Address - Phone:410-392-2731
Practice Address - Fax:410-392-2732
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU10000574225X00000X
MD04271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist