Provider Demographics
NPI:1538731963
Name:SUTTON, CAROLINE TARGONSKI (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:TARGONSKI
Last Name:SUTTON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ROSE
Other - Last Name:TARGONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1606 SHARON RD W APT 38
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-5687
Mailing Address - Country:US
Mailing Address - Phone:704-249-4455
Mailing Address - Fax:
Practice Address - Street 1:1606 SHARON RD W APT 38
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-5687
Practice Address - Country:US
Practice Address - Phone:704-249-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14248225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist