Provider Demographics
NPI:1912622010
Name:RIESETT, SUSAN (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RIESETT
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 1:31 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4022
Mailing Address - Country:US
Mailing Address - Phone:410-415-3515
Mailing Address - Fax:443-459-9550
Practice Address - Street 1:31 WALKER AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4022
Practice Address - Country:US
Practice Address - Phone:410-415-3515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist