Healthcare Provider Details

I. General information

NPI: 1346755048
Provider Name (Legal Business Name): ELYSE SUHAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROBERT GLIDDEN HALL OHIO UNIVERSITY
ATHENS OH
45701
US

IV. Provider business mailing address

1181 STATE ROUTE 681 S
ALBANY OH
45710-8911
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number11031
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: