Provider Demographics
NPI:1447688932
Name:GUGGEMOS, SUSAN (COTA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:GUGGEMOS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HORNYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:5245 BUSSENDORFER ROAD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-648-2753
Mailing Address - Fax:
Practice Address - Street 1:790 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:LAKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218
Practice Address - Country:US
Practice Address - Phone:716-822-4781
Practice Address - Fax:716-825-5765
Is Sole Proprietor?:No
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001578-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant