Provider Demographics
NPI:1528304870
Name:SUTTON, LAURA ANNE (COTA/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
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 1:17837 1ST AVE S
Mailing Address - Street 2:PMB 224
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1728
Mailing Address - Country:US
Mailing Address - Phone:206-861-5678
Mailing Address - Fax:
Practice Address - Street 1:17837 1ST AVE S
Practice Address - Street 2:PMB 224
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-1728
Practice Address - Country:US
Practice Address - Phone:206-861-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OC60299236224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant