Provider Demographics
NPI:1649552076
Name:GANN, SUSAN (OT/L)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GANN
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17512 SHADY RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-6236
Mailing Address - Country:US
Mailing Address - Phone:302-444-8318
Mailing Address - Fax:302-444-8309
Practice Address - Street 1:17512 SHADY RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-6236
Practice Address - Country:US
Practice Address - Phone:302-444-8318
Practice Address - Fax:302-444-8309
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY46TR00359400225X00000X
DEU1-0012526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist