Provider Demographics
NPI:1588988596
Name:NEPHEW, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NEPHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 BELCOR DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-8644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4407
Practice Address - Country:US
Practice Address - Phone:931-487-9787
Practice Address - Fax:931-487-9788
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3851225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist