Healthcare Provider Details

I. General information

NPI: 1184773194
Provider Name (Legal Business Name): ALICE M SUTTON RN,LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 EXECUTIVE PKWY SUITE 230
TOLEDO OH
43606-1326
US

IV. Provider business mailing address

P O BOX 74872
CLEVELAND OH
44194-4872
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-3500
  • Fax: 419-531-1877
Mailing address:
  • Phone: 419-531-3500
  • Fax: 419-531-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number33-00-8897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: