Healthcare Provider Details

I. General information

NPI: 1639491277
Provider Name (Legal Business Name): SUZANNE ELIZABETH CAESAR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS SUZANNE ELIZABETH FLEMING

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S. MAIN ST.
WEST SALEM OH
44287-0033
US

IV. Provider business mailing address

606 BANK ST.
LODI OH
44254-1012
US

V. Phone/Fax

Practice location:
  • Phone: 216-577-2950
  • Fax:
Mailing address:
  • Phone: 216-577-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.016596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: