Provider Demographics
NPI:1265221519
Name:RHODES, SUSAN MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:RHODES
Suffix:
Gender:
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1237
Mailing Address - Country:US
Mailing Address - Phone:570-529-0276
Mailing Address - Fax:
Practice Address - Street 1:105 W SHEEDY RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3334
Practice Address - Country:US
Practice Address - Phone:607-754-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009555-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant