Susan Rose Fairbairn, COTA

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

006720 Issued in NY

Practice address

415 Main St.
Margaretville, NY 12455-0319

Phone

(845) 586-2647

Fax

(845) 586-2949

NPI assigned

Oct 20, 2011

Last updated

Oct 20, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Margaretville Central School District

  • Local Education Agency (LEA)
  • Margaretville, NY
  • NPI 1124175633
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319068800000",
    "number": "1487939575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 319",
            "city": "MARGARETVILLE",
            "state": "NY",
            "postal_code": "124550319",
            "telephone_number": "845-586-2647",
            "fax_number": "845-586-2949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MAIN ST.",
            "city": "MARGARETVILLE",
            "state": "NY",
            "postal_code": "124550319",
            "telephone_number": "845-586-2647",
            "fax_number": "845-586-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBAIRN",
        "first_name": "SUSAN",
        "middle_name": "ROSE",
        "name_prefix": "Miss",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-20",
        "last_updated": "2011-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NY",
            "license": "006720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tanjia Hynes, FNP
• Carly Ann Jones, DPT
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• Community Health Worker in Margaretville, NY
• Providers in Margaretville, NY by specialty
• Community Health Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.