Basic Information
| Provider Information | |||||||||
| NPI: | 1174008924 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUTTER | ||||||||
| FirstName: | ROLANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5232 W COMANCHE ST | ||||||||
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| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874013605 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 SAGUARO TRL | ||||||||
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| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874019632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055986000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2018 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA3981 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.