Provider Demographics
NPI:1518083526
Name:LOPEZ, SUZANNE PARTRIDGE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:PARTRIDGE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 NEWAUKUM VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8873
Mailing Address - Country:US
Mailing Address - Phone:360-740-1713
Mailing Address - Fax:
Practice Address - Street 1:156 NEWAUKUM VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8873
Practice Address - Country:US
Practice Address - Phone:360-740-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001841225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7683733Medicaid