Individual
DR. SUSAN M. PROVOST-DANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1102 WINKLER AVE, KILLEEN, TX 76542-6249
(254) 634-8505
(254) 519-3477
Mailing address
8621 MOUNTAIN DR, SALADO, TX 76571-5109
(254) 947-5431
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT004598
GA
225XP0200X
Pediatric Occupational Therapist
Primary
106402
TX
Other
Enumeration date
09/26/2007
Last updated
12/09/2008
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