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General NPI Number Information
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NPI Number | 1710126727
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Entity Type | Organization
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Legal Business Name | SUMA KIDS,INC
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/13/2009
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Provider Practice Location Address
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Address Line | 1190 BURNETT AVE SUITE D
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City | CONCORD
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State | CA
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Zip | 94520-5640
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Country | US
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Telephone | 925-676-9165
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Fax | 925-676-9166
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Provider Business Mailing Address
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Address Line | 1190 BURNETT AVE SUITE D
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City | CONCORD
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State | CA
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Zip | 94520-5640
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Country | US
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Telephone | 925-676-9165
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Fax | 925-676-9166
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Authorized Official
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Title or Position | CEO
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Name | SUSAN J MARCUS
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Credential | OTR
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Telephone | 925-676-9165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3805
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License Number State | CA
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