Provider Demographics
NPI:1679231674
Name:SUTTOR, AUDREY CLAIRE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:CLAIRE
Last Name:SUTTOR
Suffix:
Gender:
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 PONDEROSA CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-9326
Mailing Address - Country:US
Mailing Address - Phone:616-994-3132
Mailing Address - Fax:
Practice Address - Street 1:1371 HECLA DR STE D130
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2318
Practice Address - Country:US
Practice Address - Phone:303-963-5582
Practice Address - Fax:720-307-3538
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007018225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist