Provider Demographics
NPI:1184438921
Name:MULLIGAN, SUSAN (OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MACINNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-0421
Mailing Address - Country:US
Mailing Address - Phone:860-284-9779
Mailing Address - Fax:860-409-2190
Practice Address - Street 1:110 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:WEATOGUE
Practice Address - State:CT
Practice Address - Zip Code:06089-9407
Practice Address - Country:US
Practice Address - Phone:860-284-9779
Practice Address - Fax:860-409-2190
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1169225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist