Provider Demographics
NPI:1306861349
Name:COMEN, MICHELE SUSAN
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:SUSAN
Last Name:COMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:SUSAN
Other - Last Name:COMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/CHT,MA
Mailing Address - Street 1:115 RIDGEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1712
Mailing Address - Country:US
Mailing Address - Phone:914-345-9133
Mailing Address - Fax:914-345-9140
Practice Address - Street 1:503 GRASSLANDS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1503
Practice Address - Country:US
Practice Address - Phone:914-345-9133
Practice Address - Fax:914-345-9133
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00769-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00769-1OtherOT LISCENSE