Provider Demographics
NPI:1922286798
Name:SULLIVAN, AMANDA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:42 ASHLAND ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3125
Mailing Address - Country:US
Mailing Address - Phone:508-386-2884
Mailing Address - Fax:
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:857-203-6584
Practice Address - Fax:857-203-5680
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist