MEDICARE: MRS. SUSAN ELSAESSER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	002901-1	NY
2	225X00000X	Occupational Therapist	002901-1	NY

General Provider Information

NPI Number	:	1134419054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN ELSAESSER OTR/L

Provider Business Mailing Address
First Line	:	152 SHELLRIDGE DR
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1390
Country	:	US
Telephone Number	:	716-689-4525
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 SHELLRIDGE DR
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1390
Country	:	US
Telephone Number	:	716-689-4525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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