Healthcare Provider Details

I. General information

NPI: 1750588950
Provider Name (Legal Business Name): VICKI B SULLIVAN OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 12/15/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW STE D
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

3901 CAPITAL MALL DR SW STE D
OLYMPIA WA
98502-8654
US

V. Phone/Fax

Practice location:
  • Phone: 360-709-6221
  • Fax: 360-359-4727
Mailing address:
  • Phone: 360-709-6221
  • Fax: 360-359-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00004355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: