Provider Demographics
NPI:1801158878
Name:GRANT, SUSAN E (OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:GRANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 DROWN LN
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-6027
Mailing Address - Country:US
Mailing Address - Phone:207-985-0374
Mailing Address - Fax:207-985-7937
Practice Address - Street 1:65 DROWN LN
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:ME
Practice Address - Zip Code:04002-6027
Practice Address - Country:US
Practice Address - Phone:207-985-0374
Practice Address - Fax:207-985-7937
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT79225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME12300642OtherCAQH