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General NPI Number Information
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NPI Number | 1417101684
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Entity Type | Individual
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Provider Name | SUSAN MELISSA OSBON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 41 REID AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3617
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Country | US
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Telephone | 718-987-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 2 PARKWOOD LN
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-2912
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Country | US
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Telephone | 917-605-7415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 008875-1
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License Number State | NY
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