Healthcare Provider Details

I. General information

NPI: 1467607887
Provider Name (Legal Business Name): SUSAN MARIE ROBERTSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20409 8TH AVE
ROCKAWAY POINT NY
11697-1809
US

IV. Provider business mailing address

20409 8TH AVE
ROCKAWAY POINT NY
11697-1809
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-6742
  • Fax:
Mailing address:
  • Phone: 718-710-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010504-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: