Basic Information
| Provider Information | |||||||||
| NPI: | 1285843854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVERI | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1195 SEVERN RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145809144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852171919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 FISHERS STATION DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | VICTOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859247207 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 09/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 002044-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.