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General NPI Number Information
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NPI Number | 1568515823
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Entity Type | Individual
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Provider Name | SUZANNE MARIE CONRAD ED.S.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 8826 LINEBROOK DR
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City | TRINITY
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State | FL
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Zip | 34655-5318
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Country | US
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Telephone | 727-444-3604
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Fax | 727-372-5360
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Provider Business Mailing Address
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Address Line | 8826 LINEBROOK DR
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City | TRINITY
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State | FL
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Zip | 34655-5318
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Country | US
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Telephone | 727-444-3604
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Fax | 727-372-5360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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