Healthcare Provider Details

I. General information

NPI: 1356590947
Provider Name (Legal Business Name): SUSAN A. EMERSON OTR, CHT, CEES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BRIXHAM RD.
YORK ME
03909
US

IV. Provider business mailing address

41 BRIXHAM RD. PO BOX 627
YORK ME
03909
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3175
  • Fax: 207-351-3175
Mailing address:
  • Phone: 207-351-3175
  • Fax: 207-351-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number97
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number150
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number97
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number97
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: