Provider Demographics
NPI:1306067566
Name:RAFFELLINI, SUZANNE C (OT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:RAFFELLINI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CANDLEWYCK DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-1436
Mailing Address - Country:US
Mailing Address - Phone:610-444-3269
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1401
Practice Address - Country:US
Practice Address - Phone:302-239-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001452225X00000X
PAOC006431L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC006431LOtherOT LICENSE
DEU1-0001452OtherOT LICENSE