Provider Demographics
NPI:1376807164
Name:DEBUTTS, SUZETTE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:DEBUTTS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 MONT BLANC PL NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-7860
Mailing Address - Country:US
Mailing Address - Phone:425-273-6633
Mailing Address - Fax:
Practice Address - Street 1:5872 MONT BLANC PL NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-7860
Practice Address - Country:US
Practice Address - Phone:425-273-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000116225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics