Provider Demographics
NPI:1821115957
Name:DEAN, SUSAN P (COTA L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:P
Last Name:DEAN
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 1:10 COVE ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3680
Mailing Address - Country:US
Mailing Address - Phone:978-667-2852
Mailing Address - Fax:
Practice Address - Street 1:30 PRINCETON BLVD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-2405
Practice Address - Country:US
Practice Address - Phone:978-454-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1581224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant