Provider Demographics
NPI:1164448700
Name:SUTTON, LESLIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 LIMON DR UNIT 258
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7662
Mailing Address - Country:US
Mailing Address - Phone:970-231-9579
Mailing Address - Fax:303-452-3087
Practice Address - Street 1:2350 LIMON DR UNIT 258
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7662
Practice Address - Country:US
Practice Address - Phone:970-231-9579
Practice Address - Fax:303-452-3087
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3590225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4139409OtherBCBS
TN620819926OtherTRICARE
TN3656749Medicaid
MS7187860Medicaid
TN620819926OtherCIGNA
MS620819926OtherBCBS
TN620819926OtherAETNA
TN7533802OtherAETNA
AR110318002Medicaid
TN3371161Medicaid
MS7187860Medicaid
TN620819926OtherAETNA