Provider Demographics
NPI:1144990789
Name:PARRY, SUSAN LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:PARRY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 WELSH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4800
Mailing Address - Country:US
Mailing Address - Phone:979-764-5829
Mailing Address - Fax:
Practice Address - Street 1:1812 WELSH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-4800
Practice Address - Country:US
Practice Address - Phone:979-764-5829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty