Provider Demographics
NPI:1134414873
Name:GAUTHIER, SUSAN (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1105
Mailing Address - Country:US
Mailing Address - Phone:305-993-0060
Mailing Address - Fax:
Practice Address - Street 1:827 84TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1105
Practice Address - Country:US
Practice Address - Phone:305-993-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist