Provider Demographics
NPI:1407901531
Name:GOCHMAN, SUSAN ANN (MPH, OTR)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:GOCHMAN
Suffix:
Gender:F
Credentials:MPH, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CANDLEWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5304
Mailing Address - Country:US
Mailing Address - Phone:631-493-0503
Mailing Address - Fax:631-462-2966
Practice Address - Street 1:30 CANDLEWOOD PATH
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5304
Practice Address - Country:US
Practice Address - Phone:631-462-2966
Practice Address - Fax:631-462-2966
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005099-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics