Provider Demographics
NPI:1679821946
Name:FRASER, SUZANNE D (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:D
Last Name:FRASER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 SHAMROCK ST NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2219
Mailing Address - Country:US
Mailing Address - Phone:540-362-5959
Mailing Address - Fax:
Practice Address - Street 1:1617 SHAMROCK ST NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2219
Practice Address - Country:US
Practice Address - Phone:540-362-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000057225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow Vision