Provider Demographics
NPI:1275647158
Name:GATTIE, SUSAN J (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:GATTIE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:ATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-0181
Mailing Address - Country:US
Mailing Address - Phone:603-675-5960
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN ST
Practice Address - Street 2:DEPT OF VETERANS AFFAIRS 116A
Practice Address - City:WRJ
Practice Address - State:VT
Practice Address - Zip Code:05009-0001
Practice Address - Country:US
Practice Address - Phone:802-295-9363
Practice Address - Fax:802-295-6389
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0049225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist