Provider Demographics
NPI:1477064541
Name:LEE, SUSAN B (MS,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SARGENT RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2552
Mailing Address - Country:US
Mailing Address - Phone:845-742-8191
Mailing Address - Fax:845-786-4068
Practice Address - Street 1:51-55 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4809
Practice Address - Fax:845-786-4068
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005168-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist