Provider Demographics
NPI:1679713895
Name:QUINTIN, SUSAN M (OTR/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:QUINTIN
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 1:5 NORTHSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-8101
Mailing Address - Country:US
Mailing Address - Phone:718-490-6626
Mailing Address - Fax:
Practice Address - Street 1:5 NORTHSIDE CIR
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-8101
Practice Address - Country:US
Practice Address - Phone:718-490-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012187-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist