Provider Demographics
NPI:1194180455
Name:HANSSON, SUZANNE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HANSSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MORELAND AVE NE UNIT 349
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2689
Mailing Address - Country:US
Mailing Address - Phone:650-557-8347
Mailing Address - Fax:
Practice Address - Street 1:1456 B MCLENDON DRIVE
Practice Address - Street 2:# 349
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30307-3030
Practice Address - Country:US
Practice Address - Phone:650-557-8347
Practice Address - Fax:650-557-8347
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT14729225X00000X
CAOT 14729225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist