Healthcare Provider Details

I. General information

NPI: 1154259539
Provider Name (Legal Business Name): KATHRYN OSULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 SHELBURNE RD STE 12
SHELBURNE VT
05482-6698
US

IV. Provider business mailing address

56 MORELLEN LN APT 1
COLCHESTER VT
05446-3935
US

V. Phone/Fax

Practice location:
  • Phone: 518-538-2424
  • Fax:
Mailing address:
  • Phone: 518-538-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: