Provider Demographics
NPI:1629220215
Name:SUTHERLAND, SONYA (MS, OTR)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2763
Mailing Address - Country:US
Mailing Address - Phone:269-544-2901
Mailing Address - Fax:269-341-9919
Practice Address - Street 1:4029 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2763
Practice Address - Country:US
Practice Address - Phone:269-544-2901
Practice Address - Fax:269-341-9919
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007474225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist