Provider Demographics
NPI:1043351257
Name:FIELDER, SUSAN MICHELLE (OT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MICHELLE
Last Name:FIELDER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MICHELLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:4601 OLD JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2921
Mailing Address - Country:US
Mailing Address - Phone:940-723-3117
Mailing Address - Fax:940-723-3140
Practice Address - Street 1:4601 OLD JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2921
Practice Address - Country:US
Practice Address - Phone:940-723-3117
Practice Address - Fax:940-723-3140
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist