Provider Demographics
NPI:1679534010
Name:GILISON, SUSAN ELIZABETH (MOT, OTR-L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:GILISON
Suffix:
Gender:F
Credentials:MOT, OTR-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2913
Mailing Address - Country:US
Mailing Address - Phone:410-822-1000
Mailing Address - Fax:
Practice Address - Street 1:300 BYRN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1908
Practice Address - Country:US
Practice Address - Phone:410-228-5511
Practice Address - Fax:410-228-0767
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05557225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist