MEDICARE: MRS. SUZANNE ADELE SEALEY MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	26553	CA

General Provider Information

NPI Number	:	1124108071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE ADELE SEALEY MPT

Provider Business Mailing Address
First Line	:	425 HIGHLAND DR
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-5515
Country	:	US
Telephone Number	:	805-934-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 OAK PARK BLVD
Second Line	:	SUITE 202
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-1821
Country	:	US
Telephone Number	:	805-473-7499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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