Provider Demographics
NPI:1962700708
Name:O'CONNOR SUTHERLAND, ALISON (ATC, OTC, AEMT)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:O'CONNOR SUTHERLAND
Suffix:
Gender:F
Credentials:ATC, OTC, AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7953
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CO
Mailing Address - Zip Code:81620-7953
Mailing Address - Country:US
Mailing Address - Phone:802-343-3379
Mailing Address - Fax:
Practice Address - Street 1:385 MOUNTAIN ESTS
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-4467
Practice Address - Country:US
Practice Address - Phone:802-343-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT100360146M00000X
246ZX2200X
VT104.00689482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant