Provider Demographics
NPI:1659730810
Name:GREENLEE, SUZANNE (PTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JEANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1407
Mailing Address - Country:US
Mailing Address - Phone:207-747-9720
Mailing Address - Fax:
Practice Address - Street 1:15 JEANNETTE AVE
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064-1407
Practice Address - Country:US
Practice Address - Phone:207-747-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3627174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist