Provider Demographics
NPI:1023235975
Name:GRISPINO, SUSAN KAY (OTR L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:GRISPINO
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:PARMELEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24694 HAWK RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-8185
Mailing Address - Country:US
Mailing Address - Phone:660-582-8105
Mailing Address - Fax:
Practice Address - Street 1:AREA COOPERATIVE FOR EDUCATIONAL SUPPORT
Practice Address - Street 2:1429 SOUTH MUNN AVENUE
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468
Practice Address - Country:US
Practice Address - Phone:660-582-3768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000840225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist