Provider Demographics
NPI:1780748921
Name:SKY, SUZANNE E (LAC, MTOM)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:E
Last Name:SKY
Suffix:
Gender:F
Credentials:LAC, MTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 A ST STE 1
Mailing Address - Street 2:ASHLAND ACUPUNCTURE
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2051
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:545 A ST STE 1
Practice Address - Street 2:ASHLAND ACUPUNCTURE
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2051
Practice Address - Country:US
Practice Address - Phone:541-488-9696
Practice Address - Fax:541-552-9684
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist