Provider Demographics
NPI:1073134680
Name:SUSS, NINA T (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:NINA
Middle Name:T
Last Name:SUSS
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 1:3777 INDEPENDENCE AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1412
Mailing Address - Country:US
Mailing Address - Phone:718-548-0808
Mailing Address - Fax:
Practice Address - Street 1:3777 INDEPENDENCE AVE APT 3L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1412
Practice Address - Country:US
Practice Address - Phone:718-548-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist