Provider Demographics
NPI:1558926477
Name:SUTTON, HEATHER SUZANNE (COTA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:SUZANNE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 DUESENBERG DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-3219
Mailing Address - Country:US
Mailing Address - Phone:260-908-7579
Mailing Address - Fax:
Practice Address - Street 1:515 N MAIN ST
Practice Address - Street 2:
Practice Address - City:AVILLA
Practice Address - State:IN
Practice Address - Zip Code:46710-9601
Practice Address - Country:US
Practice Address - Phone:260-897-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001646A224Z00000X
224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant