MEDICARE: LESLIE SUTTON OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	3590	TN

General Provider Information

NPI Number	:	1164448700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE SUTTON OTR/L

Provider Business Mailing Address
First Line	:	2350 LIMON DR UNIT 258
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7662
Country	:	US
Telephone Number	:	970-231-9579
Fax Number	:	303-452-3087

Provider Business Practice Location Address
First Line	:	2350 LIMON DR UNIT 258
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7662
Country	:	US
Telephone Number	:	970-231-9579
Fax Number	:	303-452-3087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	03/08/2021

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