Provider Demographics
NPI:1427159409
Name:MCKENNA-STUKAS, SUZANNE KAY (MS OTR)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:KAY
Last Name:MCKENNA-STUKAS
Suffix:
Gender:F
Credentials:MS OTR
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:KAY
Other - Last Name:STUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR
Mailing Address - Street 1:2233 MUIR WDS PLACE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616
Mailing Address - Country:US
Mailing Address - Phone:530-756-3183
Mailing Address - Fax:
Practice Address - Street 1:2019 ANDERSON RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616
Practice Address - Country:US
Practice Address - Phone:530-758-2222
Practice Address - Fax:530-758-2283
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3152225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist