Provider Demographics
NPI:1851565865
Name:SULLIVAN, PATRICIA MARY (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROGER ST
Mailing Address - Street 2:MARSHWOOD CENTER
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3328
Mailing Address - Country:US
Mailing Address - Phone:207-784-0108
Mailing Address - Fax:207-784-0752
Practice Address - Street 1:33 ROGER ST
Practice Address - Street 2:MARSHWOOD CENTER
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3328
Practice Address - Country:US
Practice Address - Phone:207-784-0108
Practice Address - Fax:207-784-0752
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA839224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant