Provider Demographics
NPI:1477094522
Name:SUTTON, TIA CHEYENNE (MSOTR/L)
Entity Type:Individual
Prefix:MRS
First Name:TIA
Middle Name:CHEYENNE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S YELLOWSTONE AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-1913
Mailing Address - Country:US
Mailing Address - Phone:406-698-8467
Mailing Address - Fax:
Practice Address - Street 1:612 E MAIN ST
Practice Address - Street 2:C
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3719
Practice Address - Country:US
Practice Address - Phone:406-522-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-4729225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist