Provider Demographics
NPI:1992072102
Name:LANCE, SUSAN M (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:LANCE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:913 SOUTHERLY RD
Mailing Address - Street 2:#433
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2639
Mailing Address - Country:US
Mailing Address - Phone:440-413-8351
Mailing Address - Fax:
Practice Address - Street 1:913 SOUTHERLY RD
Practice Address - Street 2:#433
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2639
Practice Address - Country:US
Practice Address - Phone:440-413-8351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04798224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1992072102Medicaid