Provider Demographics
NPI:1770200453
Name:PICK, SUZANNE I
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:I
Last Name:PICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:PA
Mailing Address - Zip Code:17752-1028
Mailing Address - Country:US
Mailing Address - Phone:570-916-5632
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003056L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant