Provider Demographics
NPI:1245440809
Name:NEURINGER, SUSAN MARA (COTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARA
Last Name:NEURINGER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 OAK HAMMOCK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6202
Mailing Address - Country:US
Mailing Address - Phone:386-299-9456
Mailing Address - Fax:
Practice Address - Street 1:500 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6171
Practice Address - Country:US
Practice Address - Phone:407-682-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA516224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant