Provider Demographics
NPI:1598012452
Name:MAMMANO, SUSAN (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MAMMANO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 DWIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3706
Mailing Address - Country:US
Mailing Address - Phone:732-892-8978
Mailing Address - Fax:
Practice Address - Street 1:2100 PANTHER PATH
Practice Address - Street 2:POINT PLEASANT BOROUGH SCHOOLS
Practice Address - City:POINT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742
Practice Address - Country:US
Practice Address - Phone:732-701-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR191600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics