Provider Demographics
NPI:1134511934
Name:SULLENGER, BRITTANY KATHRYN (OTR)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KATHRYN
Last Name:SULLENGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 REGAL OAK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4441
Mailing Address - Country:US
Mailing Address - Phone:817-266-7755
Mailing Address - Fax:
Practice Address - Street 1:12840 HILLCREST RD
Practice Address - Street 2:E104
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1528
Practice Address - Country:US
Practice Address - Phone:972-404-3077
Practice Address - Fax:972-404-1124
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116629225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist