Provider Demographics
NPI:1720579592
Name:SURIANO, CAITLIN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:
Last Name:SURIANO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1447
Mailing Address - Country:US
Mailing Address - Phone:914-346-0552
Mailing Address - Fax:
Practice Address - Street 1:168 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1447
Practice Address - Country:US
Practice Address - Phone:914-346-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009743224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant