Active NPI
Kevin Sullivan, MOTR-L
- Occupational Therapist
- Pensacola, FL
National Provider Identifier
1023479839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19447
- Practice address
- 8325 University Pkwy
Pensacola, FL 32514-4949 - Phone
- (850) 898-8000
- NPI assigned
- Mar 8, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | 3498 | NM | |
| Occupational Therapist | 225X00000X | 19447 | FL | Primary |
Addresses
Primary practice location
8325 University Pkwy
Pensacola, FL 32514-4949
Mailing address
10307 Nightwind Cir
Cantonment, FL 32533-6651
Phone (505) 710-2587
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10171568 | Medicaid | NM | |
| 326556 | Other | NM | MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3498 | NM | MD | Massage Therapist |
| 19447 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Explorabilities Inc | Occupational Therapist | Past | Accepting new patients |
| Amistad Family Services Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Las Cruces, NM
- NPI 1558654483
Occupational Therapist
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Albuquerque, NM
- NPI 1346210473
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646956800000",
"number": "1023479839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10307 NIGHTWIND CIR",
"city": "CANTONMENT",
"state": "FL",
"postal_code": "325336651",
"telephone_number": "505-710-2587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8325 UNIVERSITY PKWY",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325144949",
"telephone_number": "850-898-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "KEVIN",
"credential": "MOTR-L",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-03-08",
"last_updated": "2022-03-11",
"certification_date": "2022-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": "NM",
"license": "3498",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "19447",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10171568",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "326556",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.