Provider Demographics
NPI:1750330643
Name:DACEY, SUSAN (OT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:DACEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-0091
Mailing Address - Country:US
Mailing Address - Phone:508-248-9264
Mailing Address - Fax:508-347-7576
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:QPT
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1158
Practice Address - Country:US
Practice Address - Phone:508-347-8141
Practice Address - Fax:508-347-7576
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist