Provider Demographics
NPI:1508213547
Name:SANDERS, SUZETTE
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 W EASTMAN PL
Mailing Address - Street 2:UNIT 7-102
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-6357
Mailing Address - Country:US
Mailing Address - Phone:435-669-5719
Mailing Address - Fax:
Practice Address - Street 1:8139 W EASTMAN PL
Practice Address - Street 2:UNIT 7-102
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-6357
Practice Address - Country:US
Practice Address - Phone:435-669-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0000746224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant