Provider Demographics
NPI:1366043275
Name:SULLIVAN, AMBER LYNN (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:3750 SENTARA WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4200
Mailing Address - Country:US
Mailing Address - Phone:757-901-1580
Mailing Address - Fax:
Practice Address - Street 1:3750 SENTARA WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4200
Practice Address - Country:US
Practice Address - Phone:757-901-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001208224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant