Provider Demographics
NPI:1114689916
Name:SUTTLES, CHELSEA MARIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:MARIE
Last Name:SUTTLES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WINDRUSH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-1025
Mailing Address - Country:US
Mailing Address - Phone:217-473-9121
Mailing Address - Fax:
Practice Address - Street 1:34 WINDRUSH DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-1025
Practice Address - Country:US
Practice Address - Phone:217-473-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.002913224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant