Provider Demographics
NPI:1730513110
Name:EASON, SUZANNE PAYNE (OT/L)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PAYNE
Last Name:EASON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 COLDWELL ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7604
Mailing Address - Country:US
Mailing Address - Phone:757-472-9195
Mailing Address - Fax:
Practice Address - Street 1:2741 COLDWELL ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-7604
Practice Address - Country:US
Practice Address - Phone:757-472-9195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001133225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation