=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144383878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CORIE SULLIVAN OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2006
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 RIVERVIEW AVE STE 400
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-252-1750
-----------------------------------------------------
Fax | 833-627-5148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 RIVERVIEW AVE STE 400
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-252-1750
-----------------------------------------------------
Fax | 833-627-5148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0119000752
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 04650
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------