Healthcare Provider Details

I. General information

NPI: 1790243863
Provider Name (Legal Business Name): SUSAN KAPATOES MHA, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CONSTITUTION CT APT 119
HOPKINTON MA
01748-2916
US

IV. Provider business mailing address

5 CONSTITUTION CT APT 119
HOPKINTON MA
01748-2916
US

V. Phone/Fax

Practice location:
  • Phone: 508-282-7877
  • Fax:
Mailing address:
  • Phone: 508-282-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: