1952587651 NPI number — MRS. SUZANNE LISA DAVEY OTR/L, CLT-LANA

Table of content: MRS. SUZANNE LISA DAVEY OTR/L, CLT-LANA (NPI 1952587651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952587651 NPI number — MRS. SUZANNE LISA DAVEY OTR/L, CLT-LANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVEY
Provider First Name:
SUZANNE
Provider Middle Name:
LISA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L, CLT-LANA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMEN
Provider Other First Name:
SUZANNE
Provider Other Middle Name:
LISA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR/L, CLT-LANA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952587651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 N FEDERAL HWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-455-2121
Provider Business Mailing Address Fax Number:
954-455-2324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-455-2121
Provider Business Practice Location Address Fax Number:
954-455-2324
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT6905 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E4191A . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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