Provider Demographics
NPI:1841391711
Name:SUMMERS-LA RUSSA, SUZETTE LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:LYNN
Last Name:SUMMERS-LA RUSSA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22304 WILLOW LAKES DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-9502
Mailing Address - Country:US
Mailing Address - Phone:813-948-7925
Mailing Address - Fax:
Practice Address - Street 1:22304 WILLOW LAKES DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-9502
Practice Address - Country:US
Practice Address - Phone:813-948-7925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8465225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist