Healthcare Provider Details

I. General information

NPI: 1275620106
Provider Name (Legal Business Name): NANCY LYNN SULLIVAN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 PARKWOOD BLVD SUITE 502
FRISCO TX
75034-1928
US

IV. Provider business mailing address

11001 LA GRANGE DR
FRISCO TX
75035-6410
US

V. Phone/Fax

Practice location:
  • Phone: 972-424-0148
  • Fax: 972-422-5275
Mailing address:
  • Phone: 214-616-6007
  • Fax: 972-422-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number112501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: