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General NPI Number Information
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NPI Number | 1538249164
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Entity Type | Individual
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Provider Name | HOLLY AMBER SURIANO M.S. OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 121 CODFISH HILL RD
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City | BETHEL
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State | CT
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Zip | 06801
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Country | US
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Telephone | 475-279-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 121 CODFISH HILL RD
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City | BETHEL
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State | CT
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Zip | 06801-3203
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Country | US
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Telephone | 475-279-0347
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 004075
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 012799
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License Number State | NY
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