Provider Demographics
NPI:1184919920
Name:SWEET, SUSAN (OTR)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:SWEET
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:CONSTANTIA
Mailing Address - State:NY
Mailing Address - Zip Code:13044-2602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1683 STATE ROUTE 49
Practice Address - Street 2:
Practice Address - City:CONSTANTIA
Practice Address - State:NY
Practice Address - Zip Code:13044-2602
Practice Address - Country:US
Practice Address - Phone:315-338-4207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63 014123225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics