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General NPI Number Information
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NPI Number | 1336352137
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Entity Type | Individual
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Provider Name | JAMES ALLEN SULLIVAN OTD, OTRL
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4405 NORMAL BLVD
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City | LINCOLN
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State | NE
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Zip | 68506-5551
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Country | US
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Telephone | 402-488-2355
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Fax |
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Provider Business Mailing Address
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Address Line | 5324 W CLEVELAND AVE
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City | LINCOLN
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State | NE
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Zip | 68524-2143
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Country | US
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Telephone | 402-540-1423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1166
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License Number State | NE
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