Healthcare Provider Details

I. General information

NPI: 1447741699
Provider Name (Legal Business Name): ALEXA SULLIVAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 RIVER RIDGE DR
NORWOOD MA
02062-5027
US

IV. Provider business mailing address

64 SCHOOSETT ST
PEMBROKE MA
02359-1882
US

V. Phone/Fax

Practice location:
  • Phone: 781-335-6663
  • Fax:
Mailing address:
  • Phone: 781-335-6663
  • Fax: 781-394-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number12655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: