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General NPI Number Information
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NPI Number | 1760254759
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Entity Type | Organization
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Legal Business Name | SUSAN A RUDEEN LLC
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 136 MAIN ST, SUITE 201
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City | DANIELSON
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State | CT
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Zip | 06239-0623
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Country | US
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Telephone | 860-670-1939
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MAXWELL DR
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City | VERNON
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State | CT
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Zip | 06066-5600
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Country | US
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Telephone | 860-670-1939
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN ANN RUDEEN
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Credential | OTR
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Telephone | 860-670-1939
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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 |
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License Number State |
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