Individual
LARA SUTTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7300
Mailing address
2253 W MASON ST, GREEN BAY, WI 54303-4706
(920) 327-7300
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5385-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306161799
—
WI
Enumeration date
03/29/2010
Last updated
07/21/2016
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