Provider Demographics
NPI:1053084350
Name:SUTTNER, MELANIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SUTTNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SUTTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:728 E 1000 S
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4054
Mailing Address - Country:US
Mailing Address - Phone:831-345-7706
Mailing Address - Fax:
Practice Address - Street 1:1205 N FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8300
Practice Address - Country:US
Practice Address - Phone:801-876-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12373129-4202224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant