Provider Demographics
NPI:1114235108
Name:SUTTEN, EMILY MICHELLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MICHELLE
Last Name:SUTTEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-1083
Mailing Address - Country:US
Mailing Address - Phone:541-968-0015
Mailing Address - Fax:
Practice Address - Street 1:2436 E IRWIN WAY
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1119
Practice Address - Country:US
Practice Address - Phone:541-968-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13829172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist