Basic Information
| Provider Information | |||||||||
| NPI: | 1275620106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULLIVAN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11001 LA GRANGE DR | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750356410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146166007 | ||||||||
| FaxNumber: | 9724225275 | ||||||||
| Practice Location | |||||||||
| Address1: | 3880 PARKWOOD BLVD | ||||||||
| Address2: | SUITE 502 | ||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724240148 | ||||||||
| FaxNumber: | 9724225275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 112501 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.