Provider Demographics
NPI:1538618301
Name:AGOSTINE, SUSAN (OTR)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:AGOSTINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HUNT CLUB LN
Mailing Address - Street 2:APT H
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1893
Mailing Address - Country:US
Mailing Address - Phone:203-364-6350
Mailing Address - Fax:
Practice Address - Street 1:113 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4020
Practice Address - Country:US
Practice Address - Phone:919-777-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist