Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 00001975 | WA |
N | 225X00000X | Occupational Therapist | 986704 | OR |
N | 225XL0004X | Low Vision | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1326389503 |
---|---|
Provider Name | Mrs. Susan Dale Doyle |
First Address | Vancouver, WA 98663-2251 |
Second Address | Vancouver, WA 98663-2251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2013 |
Last Update Date | 13/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2072895 | (05) | WA |