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General NPI Number Information
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NPI Number | 1427610922
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Entity Type | Individual
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Provider Name | MAIREAD SUTHOFF ATC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 213 W MASON ST
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City | ODESSA
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State | MO
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Zip | 64076-1262
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Country | US
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Telephone | 660-233-4076
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Fax |
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Provider Business Mailing Address
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Address Line | 3366 BLUE RIDGE BLVD
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City | INDEPENDENCE
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State | MO
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Zip | 64052-1068
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Country | US
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Telephone | 540-671-3725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2026003810
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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