Healthcare Provider Details

I. General information

NPI: 1609705664
Provider Name (Legal Business Name): SUZANNE BREDERSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 CHANDLER ST
WORCESTER MA
01602-2832
US

IV. Provider business mailing address

548 CHANDLER ST
WORCESTER MA
01602-2832
US

V. Phone/Fax

Practice location:
  • Phone: 508-340-0863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4767
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: