Healthcare Provider Details

I. General information

NPI: 1154601755
Provider Name (Legal Business Name): KRISTA SUAZO OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8650 GOVERNORS HILL DR SUITE 180
CINCINNATI OH
45249-1372
US

IV. Provider business mailing address

8650 GOVERNORS HILL DR SUITE 180
CINCINNATI OH
45249-1372
US

V. Phone/Fax

Practice location:
  • Phone: 866-791-5766
  • Fax:
Mailing address:
  • Phone: 866-791-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number007853
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: