=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295073302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL C SULLIVAN OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2013
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1798 PLANK RD STE 103
-----------------------------------------------------
City | DUNCANSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16635-8389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-696-3400
-----------------------------------------------------
Fax | 814-696-3402
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 270 BRISTOL LN
-----------------------------------------------------
City | HOLLIDAYSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16648-2936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-327-8285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | OC012628
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------