Provider Demographics
NPI:1285018481
Name:SUPPA, MARIA SYDNEY (ATC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SYDNEY
Last Name:SUPPA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 CATAWBA CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-5257
Mailing Address - Country:US
Mailing Address - Phone:941-685-9934
Mailing Address - Fax:
Practice Address - Street 1:715 CATAWBA CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-5257
Practice Address - Country:US
Practice Address - Phone:941-685-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer