Provider Demographics
NPI:1548793573
Name:SULLIVAN, TOSHIA DONYELLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:TOSHIA
Middle Name:DONYELLE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Mailing Address - Street 1:142 STUART NELSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9678
Mailing Address - Country:US
Mailing Address - Phone:270-442-9502
Mailing Address - Fax:270-442-1954
Practice Address - Street 1:142 STUART NELSON PARK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9678
Practice Address - Country:US
Practice Address - Phone:270-442-9502
Practice Address - Fax:270-442-1954
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY137496225XN1300X
224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation