Provider Demographics
NPI:1306151261
Name:SULLIVAN, DENISE (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6A
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021
Mailing Address - Country:US
Mailing Address - Phone:207-829-4835
Mailing Address - Fax:207-829-4802
Practice Address - Street 1:357 TUTTLE ROAD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:ME
Practice Address - Zip Code:04021
Practice Address - Country:US
Practice Address - Phone:207-829-4835
Practice Address - Fax:207-829-4802
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME264225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist