Provider Demographics
NPI:1447500533
Name:SULLIVAN, DANIELLE (OTR/L)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
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 1:146 DAFFODIL AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3815
Mailing Address - Country:US
Mailing Address - Phone:516-233-8652
Mailing Address - Fax:
Practice Address - Street 1:104 W 29TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5310
Practice Address - Country:US
Practice Address - Phone:212-616-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017540-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist