Healthcare Provider Details

I. General information

NPI: 1508559253
Provider Name (Legal Business Name): SUTTON BATE OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date: 07/24/2026
Reactivation Date: 08/17/2026

III. Provider practice location address

9100 LAPEER RD STE C
DAVISON MI
48423-3620
US

IV. Provider business mailing address

188 BROOKSIDE DR
FLUSHING MI
48433-2602
US

V. Phone/Fax

Practice location:
  • Phone: 810-412-4183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014731
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: