Provider Demographics
NPI:1710298567
Name:ENGEL, SUSAN SHIFRA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SHIFRA
Last Name:ENGEL
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 1:762 EMPIRE BLVD
Mailing Address - Street 2:2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5633
Mailing Address - Country:US
Mailing Address - Phone:718-208-6889
Mailing Address - Fax:718-953-8363
Practice Address - Street 1:762 EMPIRE BLVD
Practice Address - Street 2:2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5633
Practice Address - Country:US
Practice Address - Phone:718-208-6889
Practice Address - Fax:718-953-8363
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015309-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist