Provider Demographics
NPI:1568087930
Name:SUTTON, LAUREEN J (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:J
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 ANDERSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-7730
Mailing Address - Country:US
Mailing Address - Phone:541-840-4636
Mailing Address - Fax:
Practice Address - Street 1:280 E HERSEY ST # B-17
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1293
Practice Address - Country:US
Practice Address - Phone:541-482-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist