Provider Demographics
NPI:1972131373
Name:SUAREZ, ADALYS
Entity type:Individual
Prefix:
First Name:ADALYS
Middle Name:
Last Name:SUAREZ
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 1:1140 SAVANNAH RIDGE ROAD, STE 111
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9634
Mailing Address - Country:US
Mailing Address - Phone:919-285-2157
Mailing Address - Fax:
Practice Address - Street 1:1140 SAVANNAH RIDGE ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9634
Practice Address - Country:US
Practice Address - Phone:919-285-2157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT20796225X00000X
NC14034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT20796OtherOCCUPATIONAL THERAPY LICENSE
NC14034OtherOCCUPATIONAL THERAPY LICENSE