Provider Demographics
NPI:1083826267
Name:ANDERSON, SUSAN A (COTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MERROW RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3937
Mailing Address - Country:US
Mailing Address - Phone:860-523-3860
Mailing Address - Fax:860-523-3819
Practice Address - Street 1:1 ABRAHMS BLVD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1508
Practice Address - Country:US
Practice Address - Phone:860-523-3860
Practice Address - Fax:860-523-3819
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000702224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant