Provider Demographics
NPI:1124220124
Name:DEASEY, SUSAN L (COTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:DEASEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:STONEBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 RIGGS RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIDDLESEX
Mailing Address - State:PA
Mailing Address - Zip Code:16159-2418
Mailing Address - Country:US
Mailing Address - Phone:724-528-9454
Mailing Address - Fax:
Practice Address - Street 1:663 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-2006
Practice Address - Country:US
Practice Address - Phone:724-983-3875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002864L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist