Provider Demographics
NPI:1215321740
Name:SUTTLE, KELLY ANN (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:SUTTLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-7008
Mailing Address - Country:US
Mailing Address - Phone:727-858-7452
Mailing Address - Fax:
Practice Address - Street 1:110 COAL CREEK DR
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-7008
Practice Address - Country:US
Practice Address - Phone:727-858-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2957225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist