Provider Demographics
NPI:1639467160
Name:KEENE, SUZANNE JANE (COTA)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:JANE
Last Name:KEENE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 MILL ST
Mailing Address - Street 2:MILL MIDDLE SCHOOL
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5129
Mailing Address - Country:US
Mailing Address - Phone:716-626-8300
Mailing Address - Fax:
Practice Address - Street 1:505 MILL ST
Practice Address - Street 2:MILL MIDDLE SCHOOL
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5129
Practice Address - Country:US
Practice Address - Phone:716-626-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY64003185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist