Provider Demographics
NPI:1245357623
Name:MONAHAN, SUSAN MANASAS (COTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MANASAS
Last Name:MONAHAN
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 1:8 LEWIS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 LEWIS POINT RD
Practice Address - Street 2:
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-5613
Practice Address - Country:US
Practice Address - Phone:508-749-8120
Practice Address - Fax:508-759-3628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant