Provider Demographics
NPI:1275868531
Name:SANTOS, SUZETTE CASTILLO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:CASTILLO
Last Name:SANTOS
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 1:60 LAWRENCE ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK ,
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1748
Mailing Address - Country:US
Mailing Address - Phone:516-328-0532
Mailing Address - Fax:
Practice Address - Street 1:472 E 57TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-451-5213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008953225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008953OtherLICENSE OT