Provider Demographics
NPI:1851947386
Name:KOLBUSZ, SUSAN AYRES (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:AYRES
Last Name:KOLBUSZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LOCKWOOD
Other - Last Name:AYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2 RUE NICOLE
Mailing Address - Street 2:
Mailing Address - City:BARKHAMSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06063-3359
Mailing Address - Country:US
Mailing Address - Phone:860-416-4447
Mailing Address - Fax:
Practice Address - Street 1:2 RUE NICOLE
Practice Address - Street 2:
Practice Address - City:BARKHAMSTED
Practice Address - State:CT
Practice Address - Zip Code:06063
Practice Address - Country:US
Practice Address - Phone:860-416-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR3256225X00000X
GAOT007221225X00000X
CT002451225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist