Provider Demographics
NPI:1972902013
Name:HOGAN, SUZANNE (OT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HEAGERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2507
Mailing Address - Country:US
Mailing Address - Phone:315-349-5558
Mailing Address - Fax:315-349-5652
Practice Address - Street 1:110 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2507
Practice Address - Country:US
Practice Address - Phone:315-349-5558
Practice Address - Fax:315-349-5652
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018497225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist