Provider Demographics
NPI:1619567914
Name:OTTOMANELLI, SUSANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:OTTOMANELLI
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 1:425 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4646
Mailing Address - Country:US
Mailing Address - Phone:862-226-6507
Mailing Address - Fax:
Practice Address - Street 1:355 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3577
Practice Address - Country:US
Practice Address - Phone:908-325-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00949900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist