Provider Demographics
NPI:1891214854
Name:LINEHAN, SUZAN JAN (BS)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:JAN
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:SUZAN
Other - Middle Name:JAN
Other - Last Name:LINEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:7320 SW HUNZIKER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2301
Mailing Address - Country:US
Mailing Address - Phone:971-770-0404
Mailing Address - Fax:503-874-6516
Practice Address - Street 1:29700 SW MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-9649
Practice Address - Country:US
Practice Address - Phone:508-728-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2177225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist