MEDICARE: SUZANNE PAYNE EASON OT/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	225XP0019X	Physical Rehabilitation Occupational Therapist	0119001133	VA

General Provider Information

NPI Number	:	1730513110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE PAYNE EASON OT/L

Provider Business Mailing Address
First Line	:	2741 COLDWELL ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7604
Country	:	US
Telephone Number	:	757-472-9195
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 COLDWELL ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-7604
Country	:	US
Telephone Number	:	757-472-9195
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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