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Individual

SUSAN J. MANCUSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
150 MANSFIELD AVE, WILLIMANTIC, CT 06226-2026
(860) 456-2232
(860) 456-2256
Mailing address
31 OLD ROUTE 7, ATTN CREDENTIALING DEPT, BROOKFIELD, CT 06804-1714
(203) 740-0020
(203) 775-0238

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
000379
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1114979226
GROUP NPI NUMBER
CT
Enumeration date
12/10/2008
Last updated
12/10/2008
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