Provider Demographics
NPI:1285843854
Name:OLIVERI, SUSAN (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:OLIVERI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 SEVERN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9144
Mailing Address - Country:US
Mailing Address - Phone:585-217-1919
Mailing Address - Fax:
Practice Address - Street 1:590 FISHERS STATION DR
Practice Address - Street 2:SUITE 130
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-924-7207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002044-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist