Provider Demographics
NPI:1457678005
Name:TUSSEY, SARAH LYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LYN
Last Name:TUSSEY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SUTPHIN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25315-1977
Mailing Address - Country:US
Mailing Address - Phone:304-749-1580
Mailing Address - Fax:
Practice Address - Street 1:1 SUPTHIN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311
Practice Address - Country:US
Practice Address - Phone:304-749-1580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1516224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant