Provider Demographics
NPI:1043650021
Name:BRANNAM, SUZANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BRANNAM
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 HEARD RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1801
Mailing Address - Country:US
Mailing Address - Phone:770-595-3575
Mailing Address - Fax:
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:B300 SUITE 302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:770-410-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002326225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist