Provider Demographics
NPI:1750029054
Name:PADILLA, SUZANNE GABRIELLE (COTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:GABRIELLE
Last Name:PADILLA
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 1:12127 SE 316TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3627
Mailing Address - Country:US
Mailing Address - Phone:253-347-1112
Mailing Address - Fax:
Practice Address - Street 1:12127 SE 316TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3627
Practice Address - Country:US
Practice Address - Phone:253-347-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60298479224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant