Provider Demographics
NPI:1982112496
Name:SEYMOUR, SUZANNE (LMST)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:LMST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 WHITES CAMP RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05455-8301
Mailing Address - Country:US
Mailing Address - Phone:802-527-1897
Mailing Address - Fax:
Practice Address - Street 1:416 ROOSEVELT HWY STE 202
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5924
Practice Address - Country:US
Practice Address - Phone:802-655-2500
Practice Address - Fax:802-655-2500
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9938225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist