Provider Demographics
NPI:1750630323
Name:SMALLINE, SUSAN (OTR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SMALLINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614-1187
Mailing Address - Country:US
Mailing Address - Phone:585-262-8100
Mailing Address - Fax:
Practice Address - Street 1:131 WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1187
Practice Address - Country:US
Practice Address - Phone:585-262-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010415225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist