MEDICARE: MS. KRISTIN SUESENS BUFF OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		OH

General Provider Information

NPI Number	:	1518276369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN SUESENS BUFF OTR/L

Provider Business Mailing Address
First Line	:	9810 BLUEGRASS PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-1906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 E 79TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-2864
Country	:	US
Telephone Number	:	502-584-9781
Fax Number	:	502-589-2409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	01/23/2020

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