Provider Demographics
NPI:1225454838
Name:SUTTON, ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 S FAIR ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1651
Mailing Address - Country:US
Mailing Address - Phone:401-465-1365
Mailing Address - Fax:
Practice Address - Street 1:1441 PARK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6632
Practice Address - Country:US
Practice Address - Phone:401-270-2500
Practice Address - Fax:401-415-6055
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT01437225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist