Provider Demographics
NPI:1932496270
Name:SULLIVAN, ERIN C (MA, OT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:C
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 PINE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2212
Mailing Address - Country:US
Mailing Address - Phone:402-391-2001
Mailing Address - Fax:402-391-2004
Practice Address - Street 1:2813 S 88TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3056
Practice Address - Country:US
Practice Address - Phone:402-391-2001
Practice Address - Fax:402-391-2004
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1568225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist