Provider Demographics
NPI:1780121905
Name:SUZUKI, MIWAKO
Entity type:Individual
Prefix:
First Name:MIWAKO
Middle Name:
Last Name:SUZUKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 SPRUCE ST
Mailing Address - Street 2:APT 48
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-2193
Mailing Address - Country:US
Mailing Address - Phone:336-558-3081
Mailing Address - Fax:
Practice Address - Street 1:1150 SPRUCE ST
Practice Address - Street 2:APT 48
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-2193
Practice Address - Country:US
Practice Address - Phone:336-558-3081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer