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NPI Code Detail

MEDICARE: MS. SUZANNE THERESA PACHECO ATC

MEDICARE: MS. SUZANNE THERESA PACHECO ATC
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
12255A2300XAthletic Trainer9596317RI

General Provider Information

NPI Number : 1962575829
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUZANNE THERESA PACHECO ATC
Provider Business Mailing Address
First Line : 13 CURRAN RD
Second Line :
City : CUMBERLAND
State : RI
Zip : 02864-8002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1681 CRANSTON ST
Second Line : SUITE A
City : CRANSTON
State : RI
Zip : 02920-5000
Country : US
Telephone Number : 401-223-0230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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Directions to “ MS. SUZANNE THERESA PACHECO ATC” Practice Location

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