Provider Demographics
NPI:1639516917
Name:SUTTER, KAITLIN R (ATC,AT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:R
Last Name:SUTTER
Suffix:
Gender:F
Credentials:ATC,AT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:R
Other - Last Name:HEISTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT, ATC
Mailing Address - Street 1:904 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-1755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0036472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer