Provider Demographics
NPI:1558778787
Name:O'CONNELL, SUZANNE ELYSE (DPT, COMT, FAAOMPT)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELYSE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:DPT, COMT, FAAOMPT
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:ELYSE
Other - Last Name:PARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11969-1526
Mailing Address - Country:US
Mailing Address - Phone:631-655-7280
Mailing Address - Fax:
Practice Address - Street 1:11 W NECK CIR
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2226
Practice Address - Country:US
Practice Address - Phone:631-655-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400119417OtherPTAN