Healthcare Provider Details

I. General information

NPI: 1841449519
Provider Name (Legal Business Name): SUSAN J OLMSTEAD O.T.R./L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 138TH ST APARTMENT 1M
JAMAICA NY
11435-1481
US

IV. Provider business mailing address

82-30 138TH STREET APARTMENT 1M
JAMAICA NY
11435-1483
US

V. Phone/Fax

Practice location:
  • Phone: 516-641-3262
  • Fax:
Mailing address:
  • Phone: 516-641-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number006861-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number006861-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: