Provider Demographics
NPI:1972709038
Name:KRIKORIAN, SUSAN JUDITH (OTRL)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JUDITH
Last Name:KRIKORIAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 OCEAN ST
Mailing Address - Street 2:#48
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3125
Mailing Address - Country:US
Mailing Address - Phone:203-510-1150
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVE
Practice Address - Street 2:#14
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1306
Practice Address - Country:US
Practice Address - Phone:781-245-4446
Practice Address - Fax:781-245-5505
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist