Corwin Sutherin
Individual provider Active NPI Occupational Therapist · Shelley, ID
NPI 1104035120 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104035120
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT-253 (ID)
- Practice address
- 1452 N 1180 E
Shelley, ID 83274-5100 - Phone
- (208) 282-2590
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT-253 | ID | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT-253 | ID | Yes |
Addresses
Primary practice location
1452 N 1180 E
Shelley, ID 83274-5100
Mailing address
1452 N 1180 E
Shelley, ID 83274-5100
Other providers in Shelley, ID
- Aubrey Joy Snell
- Kristan C Sparks
- John R Stohl
- Stone Ridge Dental Inc.
- Melanie F. Sullivan
- Ty W. Swensen
- Rigoberto Vasquez
- Benjamin Waldron
- Wellspring Weight & Wellness LLC
- Jessica Kelley Westover
All providers in Shelley, ID · Occupational Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.