Provider Demographics
NPI:1245351436
Name:SUTLEY, BRENDA G (OT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:G
Last Name:SUTLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 DAVIS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:31822-8262
Mailing Address - Country:US
Mailing Address - Phone:706-663-0249
Mailing Address - Fax:
Practice Address - Street 1:2300A MANCHESTER EXPRESSWAY
Practice Address - Street 2:SUITE 101B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-256-0825
Practice Address - Fax:706-256-0830
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist