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Individual

SHANNA SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
315 S OSTEOPATHY AVE, KIRKSVILLE, MO 63501-6401
(843) 855-0196
Mailing address
315 S OSTEOPATHY AVE, KIRKSVILLE, MO 63501-6401

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
124584
TX
225X00000X
Occupational Therapist
12600
MT
225X00000X
Occupational Therapist
Primary
2024013845
MO
225X00000X
Occupational Therapist
OTL15322
MA

Other

Enumeration date
08/18/2025
Last updated
08/18/2025
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