Provider Demographics
NPI:1396023388
Name:SULLIVAN, KATHLEEN T (OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21031 STATE HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-7402
Mailing Address - Country:US
Mailing Address - Phone:607-746-7287
Mailing Address - Fax:
Practice Address - Street 1:6678 COUNTY ROAD 32
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3554
Practice Address - Country:US
Practice Address - Phone:607-335-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002160-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist