Provider Demographics
NPI:1508167503
Name:ELLER, SUZANNE H (LMBT)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:H
Last Name:ELLER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 36TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3251
Mailing Address - Country:US
Mailing Address - Phone:828-324-8620
Mailing Address - Fax:
Practice Address - Street 1:318 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4944
Practice Address - Country:US
Practice Address - Phone:828-315-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist