Healthcare Provider Details

I. General information

NPI: 1568520062
Provider Name (Legal Business Name): SUSAN MARTIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

43 LEVEL ACRES RD
ATTLEBORO MA
02703-6843
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8661
  • Fax:
Mailing address:
  • Phone: 508-761-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number236
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4146
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: