Individual
AMANDA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
6811 CAMPFIELD RD, BALTIMORE, MD 21207-4657
(410) 486-4573
(443) 471-0105
Mailing address
109 WOODBROOK LN, BALTIMORE, MD 21212-1035
(908) 216-3193
(214) 305-3399
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
08428
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08428
—
MD
Enumeration date
04/15/2019
Last updated
04/15/2019
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