Provider Demographics
NPI:1124519582
Name:SUTTON, DENISE (COTA/L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7985 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NASHPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43830-9596
Mailing Address - Country:US
Mailing Address - Phone:740-221-9663
Mailing Address - Fax:
Practice Address - Street 1:526 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-1033
Practice Address - Country:US
Practice Address - Phone:614-504-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant