Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 398057 | OR |
NPI | 1336462951 |
---|---|
Provider Name | Ms. Suzanne E Lazaro |
First Address | Corvallis, OR 97330-9251 |
Second Address | Corvallis, OR 97330-9251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2010 |
Last Update Date | 10/03/2010 |