Provider Demographics
NPI:1538249164
Name:SURIANO, HOLLY AMBER (MS OTR/L)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:AMBER
Last Name:SURIANO
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:AMBER
Other - Last Name:POLMATEER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 CODFISH HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-3203
Mailing Address - Country:US
Mailing Address - Phone:475-279-0347
Mailing Address - Fax:
Practice Address - Street 1:121 CODFISH HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801
Practice Address - Country:US
Practice Address - Phone:475-279-0347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004075225X00000X
NY012799225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist