Provider Demographics
NPI:1134523582
Name:PITTMAN, SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 GUTHRIE AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-3019
Mailing Address - Country:US
Mailing Address - Phone:515-299-1729
Mailing Address - Fax:
Practice Address - Street 1:2571 GUTHRIE AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317-3019
Practice Address - Country:US
Practice Address - Phone:515-299-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01588225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist