Healthcare Provider Details

I. General information

NPI: 1710130869
Provider Name (Legal Business Name): SUZIE DORSAINVIL OCCUP. THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2008
Last Update Date: 11/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MOLYNEAUX RD
VALLEY STREAM NY
11580-1925
US

IV. Provider business mailing address

39 MOLYNEAUX RD
VALLEY STREAM NY
11580-1925
US

V. Phone/Fax

Practice location:
  • Phone: 516-561-9522
  • Fax: 516-561-9522
Mailing address:
  • Phone: 516-561-9522
  • Fax: 516-561-9522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number004989
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number004989
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number004989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: