Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0178 | AL |
NPI | 1063561637 |
---|---|
Provider Name | Sharon Lynn Sutton |
First Address | Northport, AL 35476-2814 |
Second Address | Northport, AL 35476-2814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07376 | (02) | AL |
51505518SUT | BCBS PROVIDER (01) | AL |