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General NPI Number Information
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NPI Number | 1609793819
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Entity Type | Individual
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Provider Name | EMMA FAUSTINA SULLIVAN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 220 FORBES RD
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City | BRAINTREE
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State | MA
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Zip | 02184-2705
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Country | US
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Telephone | 617-322-2694
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Fax |
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Provider Business Mailing Address
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Address Line | 114 BROOK ST
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City | BROOKLINE
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State | MA
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Zip | 02445-7186
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Country | US
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Telephone | 603-716-4031
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTL36315
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License Number State | MA
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