Individual
SUSAN C VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1580 ARMORY DR STE B, FRANKLIN, VA 23851-2470
(757) 562-0990
(757) 562-0496
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119000324
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043237936
—
VA
05
—
1548387541
—
VA
01
—
C10066
MEDICARE PTAN
VA
Enumeration date
03/23/2007
Last updated
05/12/2022
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