Individual
KEVIN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOTR-L
Contact information
Practice address
8325 UNIVERSITY PKWY, PENSACOLA, FL 32514-4949
(850) 898-8000
Mailing address
10307 NIGHTWIND CIR, CANTONMENT, FL 32533-6651
(505) 710-2587
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
19447
FL
225XP0200X
Pediatric Occupational Therapist
3498
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10171568
—
NM
01
—
326556
MEDICARE
NM
Enumeration date
03/08/2016
Last updated
03/11/2022
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