Provider Demographics
NPI:1932279155
Name:SULLIVAN, JAMES F (OTRL)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:F
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2436
Mailing Address - Country:US
Mailing Address - Phone:828-253-6142
Mailing Address - Fax:
Practice Address - Street 1:184 E CHESTNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2377
Practice Address - Country:US
Practice Address - Phone:828-250-0474
Practice Address - Fax:828-250-0767
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13401OtherBLUE CROSS BLUE SHIELD
NC2511007Medicare ID - Type Unspecified