Provider Demographics
NPI:1578866315
Name:EMERSON, SUSAN M (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:EMERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KIRKLAND VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-4797
Mailing Address - Country:US
Mailing Address - Phone:610-691-4551
Mailing Address - Fax:
Practice Address - Street 1:1 KIRKLAND VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4797
Practice Address - Country:US
Practice Address - Phone:610-691-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006937224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant