Provider Demographics
NPI:1275620106
Name:SULLIVAN, NANCY LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LYNN
Last Name:SULLIVAN
Suffix:
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 1:11001 LA GRANGE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6410
Mailing Address - Country:US
Mailing Address - Phone:214-616-6007
Mailing Address - Fax:972-422-5275
Practice Address - Street 1:3880 PARKWOOD BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1928
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK161641206OtherTIN