Healthcare Provider Details

I. General information

NPI: 1336482595
Provider Name (Legal Business Name): SARINA S USSACH MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NEWMAN AVE UNIT 3201
RUMFORD RI
02916-3607
US

IV. Provider business mailing address

20 NEWMAN AVE UNIT 3201
RUMFORD RI
02916-3607
US

V. Phone/Fax

Practice location:
  • Phone: 413-210-6719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9661
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3488
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT01370
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: