Provider Demographics
NPI:1881297612
Name:AMIOTT, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:AMIOTT
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 1:1245 LEEWARD LN
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7007
Mailing Address - Country:US
Mailing Address - Phone:440-376-5989
Mailing Address - Fax:
Practice Address - Street 1:1245 LEEWARD LN
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7007
Practice Address - Country:US
Practice Address - Phone:440-376-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43012223747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider