Healthcare Provider Details

I. General information

NPI: 1164630661
Provider Name (Legal Business Name): DIANE WELTER SULLIVAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SWEETEN CREEK RD
ASHEVILLE NC
28803-2318
US

IV. Provider business mailing address

56 SHERWOOD RD
ASHEVILLE NC
28803-2436
US

V. Phone/Fax

Practice location:
  • Phone: 828-274-2400
  • Fax:
Mailing address:
  • Phone: 828-253-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1072
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: