Provider Demographics
NPI:1790937381
Name:CECIL, SUSANNE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:CECIL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0136
Mailing Address - Country:US
Mailing Address - Phone:330-206-5299
Mailing Address - Fax:
Practice Address - Street 1:208 MICHELLE DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0136
Practice Address - Country:US
Practice Address - Phone:330-206-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009010789224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant