Provider Demographics
NPI:1912202540
Name:QUATTROCIOCCHI, SUSAN STEIN (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:STEIN
Last Name:QUATTROCIOCCHI
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 SW ROXBURY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-4177
Mailing Address - Country:US
Mailing Address - Phone:206-937-2000
Mailing Address - Fax:206-937-4643
Practice Address - Street 1:2656 SW ROXBURY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-4177
Practice Address - Country:US
Practice Address - Phone:206-937-2000
Practice Address - Fax:206-937-4643
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60196727225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist