Provider Demographics
NPI:1174679971
Name:SCHEVENE, SUZANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SCHEVENE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BARNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:811 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1121
Mailing Address - Country:US
Mailing Address - Phone:541-993-2847
Mailing Address - Fax:
Practice Address - Street 1:414 WASHINGTON ST
Practice Address - Street 2:2B
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2262
Practice Address - Country:US
Practice Address - Phone:541-993-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9618225700000X
WAMA00007742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist