Provider Demographics
NPI:1730964503
Name:INGLIN, SUSANNA ROSE (MSOT, OTR/L)
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:ROSE
Last Name:INGLIN
Suffix:
Gender:F
Credentials:MSOT, 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:PO BOX 3106
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08543
Mailing Address - Country:US
Mailing Address - Phone:609-955-1440
Mailing Address - Fax:888-977-3213
Practice Address - Street 1:4437 RT 27
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-955-1440
Practice Address - Fax:888-977-3213
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01002400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist