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Individual

MRS. SUSAN L GOULDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1428 5TH AVENUE, BAY SHORE, NY 11706-4153
(631) 665-1900
Mailing address
10 HARBOURPOINT DRIVE, NORTHPORT, NY 11768-1556

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
013457-1
NY

Other

Enumeration date
12/17/2010
Last updated
12/17/2010
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