Basic Information
| Provider Information | |||||||||
| NPI: | 1114148350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DENHAM | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OTR, CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 TECHNACENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361176028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346255795 | ||||||||
| FaxNumber: | 3343964905 | ||||||||
| Practice Location | |||||||||
| Address1: | 7057 HALCYON SUMMIT DR | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361176927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3346255809 | ||||||||
| FaxNumber: | 3342712555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0181 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225XH1200X | 1021100145 | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | 12476820 | 01 | AL | CAQH | OTHER | 511-46590 | 01 | AL | BCBS OF AL | OTHER |