Provider Demographics
NPI:1063799104
Name:KING, SUSAN JOY (OTR)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOY
Last Name:KING
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 1:5 SHIELDS RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-6028
Mailing Address - Country:US
Mailing Address - Phone:516-359-5858
Mailing Address - Fax:845-838-6978
Practice Address - Street 1:10 EDUCATION DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-4066
Practice Address - Country:US
Practice Address - Phone:845-838-6900
Practice Address - Fax:845-838-6978
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013257-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist