Provider Demographics
NPI:1366764318
Name:SULLIVAN, LORI BULLOCK (MS,OT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BULLOCK
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS,OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 APPLETREE POINT RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2615
Mailing Address - Country:US
Mailing Address - Phone:802-860-6072
Mailing Address - Fax:
Practice Address - Street 1:424 CREEK FARM RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-7102
Practice Address - Country:US
Practice Address - Phone:802-238-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT072-0000087225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics