Provider Demographics
NPI:1154937423
Name:SUTTON-BERG, LOUISE (OTR)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:SUTTON-BERG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 AZALEA TER
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-9414
Mailing Address - Country:US
Mailing Address - Phone:248-739-3247
Mailing Address - Fax:
Practice Address - Street 1:4913 PROFESSIONAL CT STE 209
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-1926
Practice Address - Country:US
Practice Address - Phone:919-948-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3789225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist