Provider Demographics
NPI:1467607887
Name:ROBERTSON, SUSAN MARIE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MARIE
Last Name:ROBERTSON
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 1:20409 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11697-1809
Mailing Address - Country:US
Mailing Address - Phone:718-710-6742
Mailing Address - Fax:
Practice Address - Street 1:20409 8TH AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY POINT
Practice Address - State:NY
Practice Address - Zip Code:11697-1809
Practice Address - Country:US
Practice Address - Phone:718-710-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010504-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist