Provider Demographics
NPI:1861723660
Name:CORBY, SUSAN MARIE (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:CORBY
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GRAEFF ST
Mailing Address - Street 2:
Mailing Address - City:CRESSONA
Mailing Address - State:PA
Mailing Address - Zip Code:17929-1501
Mailing Address - Country:US
Mailing Address - Phone:570-640-7602
Mailing Address - Fax:
Practice Address - Street 1:49 GRAEFF ST
Practice Address - Street 2:
Practice Address - City:CRESSONA
Practice Address - State:PA
Practice Address - Zip Code:17929-1501
Practice Address - Country:US
Practice Address - Phone:570-640-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC-002202-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist