Healthcare Provider Details

I. General information

NPI: 1871951087
Provider Name (Legal Business Name): CRISTINE SUTTER OCCUPATIONAL THERAPI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 W COOK RD
MANSFIELD OH
44907-5012
US

IV. Provider business mailing address

856 W COOK RD
MANSFIELD OH
44907-5012
US

V. Phone/Fax

Practice location:
  • Phone: 419-525-6400
  • Fax:
Mailing address:
  • Phone: 419-525-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.002153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: