Provider Demographics
NPI:1922496512
Name:SUDDATH, SUZANNE DENISE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:DENISE
Last Name:SUDDATH
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 1:4208 S REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1474
Mailing Address - Country:US
Mailing Address - Phone:918-695-5298
Mailing Address - Fax:
Practice Address - Street 1:4350 WILL ROGERS PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1826
Practice Address - Country:US
Practice Address - Phone:800-687-5345
Practice Address - Fax:405-948-2807
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOA367224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant