Basic Information
Provider Information | |||||||||
NPI: | 1427125673 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOSTER | ||||||||
FirstName: | SUE ELLEN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | OTRL, M ED | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 201 CHESTNUT AVE | ||||||||
Address2: |   | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166014927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149465411 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 201 CHESTNUT AVE | ||||||||
Address2: |   | ||||||||
City: | ALTOONA | ||||||||
State: | PA | ||||||||
PostalCode: | 166014927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8149448177 | ||||||||
FaxNumber: | 8149447413 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/30/2006 | ||||||||
LastUpdateDate: | 03/26/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/26/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OC001607L | PA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 7268635 | 01 | PA | AETNA | OTHER | 0017610720005 | 05 | PA |   | MEDICAID | 1779331 | 01 | PA | HIGHMARK | OTHER | 248971 | 01 | PA | HEALTH AMERICA | OTHER |