Provider Demographics
NPI:1518131994
Name:MCNUTT, SUSAN A (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:MCNUTT
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 1:348 W KING TUT RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9652
Mailing Address - Country:US
Mailing Address - Phone:360-398-2772
Mailing Address - Fax:360-398-2772
Practice Address - Street 1:348 W KING TUT RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9652
Practice Address - Country:US
Practice Address - Phone:360-398-2772
Practice Address - Fax:360-398-2772
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001123225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7680911Medicaid