Provider Demographics
NPI:1932942760
Name:BROGAN, SUSAN CUNEO (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CUNEO
Last Name:BROGAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-2300
Mailing Address - Country:US
Mailing Address - Phone:610-388-5630
Mailing Address - Fax:484-259-0141
Practice Address - Street 1:1660 E STREET RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2300
Practice Address - Country:US
Practice Address - Phone:610-388-5630
Practice Address - Fax:484-259-0141
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC003603L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist