Healthcare Provider Details

I. General information

NPI: 1760728174
Provider Name (Legal Business Name): BROOKE SUTTON M.A., OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 K ST NW SUITE 700
WASHINGTON DC
20001-4425
US

IV. Provider business mailing address

303 HILLANDALE AVE
HARRISONBURG VA
22801-1527
US

V. Phone/Fax

Practice location:
  • Phone: 202-265-5477
  • Fax:
Mailing address:
  • Phone: 304-685-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07417
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1608
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010000986
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: