Provider Demographics
NPI:1992915094
Name:SULLIVAN, DANA SULLIVAN (OTR/L)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:SULLIVAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:PASOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:P.O. BOX 111843
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511
Mailing Address - Country:US
Mailing Address - Phone:907-230-1952
Mailing Address - Fax:907-868-8657
Practice Address - Street 1:235 E. 9TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-334-9001
Practice Address - Fax:907-868-8657
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1278225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT32411Medicaid