Active NPI
Suzanne Spak, OTR
- Occupational Therapist
- Shelton, CT
National Provider Identifier
1033126305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 002804
- Practice address
- 2 Trap Falls Rd Ste 404
Shelton, CT 06484-7622 - Phone
- (203) 734-7900
- Fax
- (203) 513-3269
- NPI assigned
- Aug 1, 2006
- Last updated
- Feb 8, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 002804 | CT | Primary |
Addresses
Primary practice location
2 Trap Falls Rd Ste 404
Shelton, CT 06484-7622
Mailing address
2 Trap Falls Rd Ste 404
Shelton, CT 06484-7622
Phone (203) 734-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002804 | CT | MD | Clinical Social Worker |
| 2804 | CT | MD | Physician Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549584000000",
"number": "1033126305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 TRAP FALLS RD STE 404",
"city": "SHELTON",
"state": "CT",
"postal_code": "064847622",
"telephone_number": "203-734-7900",
"fax_number": "203-513-3269"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 TRAP FALLS RD STE 404",
"city": "SHELTON",
"state": "CT",
"postal_code": "064847622",
"telephone_number": "203-734-7900",
"fax_number": "203-513-3269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPAK",
"first_name": "SUZANNE",
"credential": "OTR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2019-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CT",
"license": "002804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shelton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.