Healthcare Provider Details

I. General information

NPI: 1699928663
Provider Name (Legal Business Name): LARA SUZANNE CHASE B-K LICENSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 PERCUSSION DR PREEMIES & ASSOCIATES, LLC
APEX NC
27539-3611
US

IV. Provider business mailing address

7829 PERCUSSION DR PREEMIES & ASSOCIATES, LLC
APEX NC
27539-3611
US

V. Phone/Fax

Practice location:
  • Phone: 919-363-7585
  • Fax: 919-303-3939
Mailing address:
  • Phone: 919-363-7585
  • Fax: 919-303-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number8700014
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: