Provider Demographics
NPI:1538302641
Name:DENTON, SUESANA (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SUESANA
Middle Name:
Last Name:DENTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9554
Mailing Address - Country:US
Mailing Address - Phone:859-322-9594
Mailing Address - Fax:859-818-0890
Practice Address - Street 1:1828 TANNER RD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9554
Practice Address - Country:US
Practice Address - Phone:859-322-9594
Practice Address - Fax:859-818-0890
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005010-1224Z00000X
KY164315224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant