Provider Demographics
NPI:1346673464
Name:BRAZILE, SUZETTA ROGERS (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTA
Middle Name:ROGERS
Last Name:BRAZILE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:91 BARRINGTON FARMS PKWY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1853
Mailing Address - Country:US
Mailing Address - Phone:404-667-5158
Mailing Address - Fax:404-667-5158
Practice Address - Street 1:91 BARRINGTON FARMS PKWY
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-1853
Practice Address - Country:US
Practice Address - Phone:404-667-5158
Practice Address - Fax:404-667-5158
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE02440225X00000X, 225XG0600X, 225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health