MEDICARE: SONYA SUTHERLAND MS, OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201007474	MI

General Provider Information

NPI Number	:	1629220215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA SUTHERLAND MS, OTR

Provider Business Mailing Address
First Line	:	4029 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-544-2901
Fax Number	:	269-341-9919

Provider Business Practice Location Address
First Line	:	4029 W MAIN ST
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49006-2763
Country	:	US
Telephone Number	:	269-544-2901
Fax Number	:	269-341-9919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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