Provider Demographics
NPI:1043535057
Name:WEST, SUZANNE MAY (OTR)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAY
Last Name:WEST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:MAY
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0795
Mailing Address - Country:US
Mailing Address - Phone:802-258-7794
Mailing Address - Fax:802-258-9702
Practice Address - Street 1:441 WEST RIVER ROAD
Practice Address - Street 2:SUITE 1N
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9088
Practice Address - Country:US
Practice Address - Phone:802-258-7794
Practice Address - Fax:802-258-7794
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026040OtherMEDICARE PTAN
VT1017691Medicaid