Provider Demographics
NPI:1851677769
Name:SHORTRIDGE, SUSAN D (MHS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:SHORTRIDGE
Suffix:
Gender:F
Credentials:MHS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W IVANHOE BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6323
Mailing Address - Country:US
Mailing Address - Phone:407-375-7871
Mailing Address - Fax:407-209-3503
Practice Address - Street 1:1110 W IVANHOE BLVD APT 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6323
Practice Address - Country:US
Practice Address - Phone:407-375-7871
Practice Address - Fax:407-209-3503
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 544225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist