MEDICARE: PAM ELIZABETH SUTTER OTR

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	225X00000X	Occupational Therapist	5201000763	MI

General Provider Information

NPI Number	:	1982181210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAM ELIZABETH SUTTER OTR

Provider Business Mailing Address
First Line	:	5608 CASPER DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-3364
Country	:	US
Telephone Number	:	248-890-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	10770 ELIZABETH LAKE RD
Second Line	:
City	:	WHITE LAKE
State	:	MI
Zip	:	48386-2136
Country	:	US
Telephone Number	:	248-618-4100
Fax Number	:

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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