Provider Demographics
NPI:1023398856
Name:ALLEGRO, SUSAN FAY (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:FAY
Last Name:ALLEGRO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SHOREVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5946
Mailing Address - Country:US
Mailing Address - Phone:704-677-3633
Mailing Address - Fax:
Practice Address - Street 1:1086 JENKINS BRANCH LN
Practice Address - Street 2:CONTACT EMAIL: DEATONA@BELLSOUTH.NET
Practice Address - City:MOUNT ULLA
Practice Address - State:NC
Practice Address - Zip Code:28125-8699
Practice Address - Country:US
Practice Address - Phone:704-677-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist