Provider Demographics
NPI:1033287750
Name:CRESSWELL, SUZANNE MARY (PT, OT, CHT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:CRESSWELL
Suffix:
Gender:F
Credentials:PT, OT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2525
Mailing Address - Country:US
Mailing Address - Phone:530-244-7686
Mailing Address - Fax:
Practice Address - Street 1:2449 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2525
Practice Address - Country:US
Practice Address - Phone:530-244-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5351225X00000X
CAPT13809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0883080001Medicare NSC