Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 0181 | AL |
N | 225XH1200X | Occupational Therapist - Hand | 1021100145 | AL |
NPI | 1114148350 |
---|---|
Provider Name | Dr. Susan Denham |
First Address | Montgomery, AL 36117-6028 |
Second Address | Montgomery, AL 36117-6927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12476820 | CAQH (01) | AL |
511-46590 | BCBS OF AL (01) | AL |