Healthcare Provider Details

I. General information

NPI: 1184861510
Provider Name (Legal Business Name): SUSAN ELIZABETH DAQUILA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 MACE ST
STATEN ISLAND NY
10306-1406
US

IV. Provider business mailing address

254 MACE ST
STATEN ISLAND NY
10306-1406
US

V. Phone/Fax

Practice location:
  • Phone: 718-668-2969
  • Fax:
Mailing address:
  • Phone: 718-668-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007-158
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number007-158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: