Healthcare Provider Details

I. General information

NPI: 1699418053
Provider Name (Legal Business Name): MARY ELIZABETH SUTHERLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COOPER AVE
SAGINAW MI
48602
US

IV. Provider business mailing address

3940 HERMANSAU DR APT. 7
SAGINAW MI
48603
US

V. Phone/Fax

Practice location:
  • Phone: 512-639-2375
  • Fax:
Mailing address:
  • Phone: 989-714-1080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201014534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: