Provider Demographics
NPI:1740742816
Name:SULLIVAN, ASHLEY I (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SULLIVAN
Suffix:I
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:N58W24552 RAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-5050
Mailing Address - Country:US
Mailing Address - Phone:262-893-9509
Mailing Address - Fax:
Practice Address - Street 1:N58W24552 RAVEN CT
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-5050
Practice Address - Country:US
Practice Address - Phone:262-893-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6487-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist