MEDICARE: MRS. DIANA SUE HUTTON M.ED.

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	222Q00000X	Developmental Therapist	000044611	KY

General Provider Information

NPI Number	:	1558501643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA SUE HUTTON M.ED.

Provider Business Mailing Address
First Line	:	852 DEER RIDGE CT
Second Line	:
City	:	VILLA HILLS
State	:	KY
Zip	:	41017-4009
Country	:	US
Telephone Number	:	859-802-7816
Fax Number	:	859-341-9053

Provider Business Practice Location Address
First Line	:	852 DEER RIDGE CT
Second Line	:
City	:	VILLA HILLS
State	:	KY
Zip	:	41017-4009
Country	:	US
Telephone Number	:	859-802-7816
Fax Number	:	859-341-9053

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/17/2014

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