Provider Demographics
NPI:1154562437
Name:KURGAN, SUSAN MARIE (COTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:KURGAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RISLEY STREET
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2720
Mailing Address - Country:US
Mailing Address - Phone:716-366-6898
Mailing Address - Fax:
Practice Address - Street 1:423 MAIN STREET
Practice Address - Street 2:OCCUPATIONAL THERAPY & HAND REHAB.
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2920
Practice Address - Country:US
Practice Address - Phone:716-366-3417
Practice Address - Fax:716-366-3568
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007276224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant