Provider Demographics
NPI:1154008225
Name:SUTTON, PAMELA M (OT/L)
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:M
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 LAMOYNE CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5914
Mailing Address - Country:US
Mailing Address - Phone:703-786-5460
Mailing Address - Fax:
Practice Address - Street 1:7500 LAMOYNE CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5914
Practice Address - Country:US
Practice Address - Phone:703-786-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist