Provider Demographics
NPI:1942423496
Name:SUTLEY, LINDSAY D (OTR)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:D
Last Name:SUTLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36536-0635
Mailing Address - Country:US
Mailing Address - Phone:251-961-7779
Mailing Address - Fax:
Practice Address - Street 1:21040 MIFLIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-9296
Practice Address - Country:US
Practice Address - Phone:251-923-0888
Practice Address - Fax:850-469-7585
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL03217225X00000X
FL0820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1942423496Medicare PIN