Provider Demographics
NPI:1770311706
Name:HINOJOSA, SUSAN (OTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BIRDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-1361
Mailing Address - Country:US
Mailing Address - Phone:979-542-1755
Mailing Address - Fax:
Practice Address - Street 1:1401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-1361
Practice Address - Country:US
Practice Address - Phone:979-542-1755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210907224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant