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General NPI Number Information
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NPI Number | 1932417649
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Entity Type | Individual
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Provider Name | SUSAN O. SHAFFER OTR/L
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 9479 MAYNARD DRIVE
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City | MARCY
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State | NY
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Zip | 13403
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Country | US
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Telephone | 315-266-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 5 THARRAT PL
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City | WHITESBORO
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State | NY
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Zip | 13492-1615
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Country | US
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Telephone | 315-736-2875
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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 | 000437-1
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License Number State | NY
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