Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | ||
N | 225X00000X | Occupational Therapist |
NPI | 1033390612 |
---|---|
Provider Name | Ms. Susan E Shoulders |
First Address | Louisville, KY 40291-0286 |
Second Address | Mt Washington, KY 40047-7843 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2007 |
Last Update Date | 07/02/2020 |