Organization
SUPPLMENTAL HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN SMITH OT (OCCUPATIONAL THERAPIST)
20952348745
Entity
Organization
Contact information
Practice address
1717 MARSTON WAY, MODESTO, CA 95355-1940
(209) 523-8745
Mailing address
1717 MARSTON WAY, MODESTO, CA 95355-1940
(209) 523-8745
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
OT534
CA
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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