Provider Demographics
NPI:1427224260
Name:NUTT, JUDITH SAGLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:SAGLE
Last Name:NUTT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:GERALDINE
Other - Last Name:SAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:503 N ACRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:65556-8322
Mailing Address - Country:US
Mailing Address - Phone:573-765-4072
Mailing Address - Fax:
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105
Practice Address - Country:US
Practice Address - Phone:800-677-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4798224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant