Basic Information
| Provider Information | |||||||||
| NPI: | 1164563995 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THATCHER | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 WEATHERVANE DRIVE | ||||||||
| Address2: | APT 25 | ||||||||
| City: | WASHINGTONVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454967828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 162 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127018815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457961350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 002758-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.