Healthcare Provider Details

I. General information

NPI: 1497683312
Provider Name (Legal Business Name): ALLISON KELLEHER SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MOWRY ST
MENDON MA
01756-1220
US

IV. Provider business mailing address

10 MOWRY ST
MENDON MA
01756-1220
US

V. Phone/Fax

Practice location:
  • Phone: 413-262-8747
  • Fax:
Mailing address:
  • Phone: 413-262-8747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: