Provider Demographics
NPI:1629270475
Name:LUSCOMB, SUSAN M (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:LUSCOMB
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:LUSCOMB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:240 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-7134
Mailing Address - Country:US
Mailing Address - Phone:978-382-5839
Mailing Address - Fax:978-945-5700
Practice Address - Street 1:240 PLEASANT ST UNIT 2
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-7134
Practice Address - Country:US
Practice Address - Phone:978-382-5839
Practice Address - Fax:978-945-5700
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1763225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics