Provider Demographics
NPI:1851961254
Name:SOSUNOV, AMANDA GRACE (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GRACE
Last Name:SOSUNOV
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:GRACE
Other - Last Name:FALSETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2-22 BANTA PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3058
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2-22 BANTA PL
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3058
Practice Address - Country:US
Practice Address - Phone:732-784-3578
Practice Address - Fax:732-924-3147
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025779225X00000X
NJ46TR01009900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist