Provider Demographics
NPI:1477079200
Name:CORRALES, SUSANNE KATHERINE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:KATHERINE
Last Name:CORRALES
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 1:185 GREAT NECK RD STE 466
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3312
Mailing Address - Country:US
Mailing Address - Phone:516-487-3032
Mailing Address - Fax:
Practice Address - Street 1:185 GREAT NECK RD STE 466
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3312
Practice Address - Country:US
Practice Address - Phone:516-487-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021747225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand