Provider Demographics
NPI:1902874035
Name:HALE, SUZANNE M (OTRL CHT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:M
Last Name:HALE
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SHINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:689 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1455
Mailing Address - Country:US
Mailing Address - Phone:321-674-5035
Mailing Address - Fax:321-674-5039
Practice Address - Street 1:689 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1455
Practice Address - Country:US
Practice Address - Phone:321-674-5035
Practice Address - Fax:321-674-5039
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT0002295225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand