Provider Demographics
NPI:1245761527
Name:MCCARTY, SUSAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 29TH LN E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3804
Mailing Address - Country:US
Mailing Address - Phone:941-447-2299
Mailing Address - Fax:
Practice Address - Street 1:5381 DESOTO RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34235-2618
Practice Address - Country:US
Practice Address - Phone:941-355-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9404224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant