Provider Demographics
NPI:1467597013
Name:RAFFERTY, SUSAN THOMPSON (ATC,L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:THOMPSON
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:ATC,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2116
Mailing Address - Country:US
Mailing Address - Phone:860-386-4519
Mailing Address - Fax:
Practice Address - Street 1:185 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2116
Practice Address - Country:US
Practice Address - Phone:860-386-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer