Provider Demographics
NPI:1760667380
Name:GREGORZEK, SUSANNA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:
Last Name:GREGORZEK
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 1:2 DUDLEY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3236
Mailing Address - Country:US
Mailing Address - Phone:401-457-1581
Mailing Address - Fax:401-831-0500
Practice Address - Street 1:2 DUDLEY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-3236
Practice Address - Country:US
Practice Address - Phone:401-457-1581
Practice Address - Fax:401-831-0500
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1045424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI01152OtherRI LICENSE