Active NPI
Shawna Sullivan, OTR/L
- Occupational Therapist
- Worcester, MA
National Provider Identifier
1073972436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 10176
- Practice address
- 799 W Boylston St
Worcester, MA 01606-3071 - Phone
- (774) 314-5393
- NPI assigned
- Feb 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 10176 | MA | Primary |
Addresses
Primary practice location
799 W Boylston St
Worcester, MA 01606-3071
Mailing address
799 W Boylston St
Worcester, MA 01606-3071
Phone (774) 314-5393
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10176 | MA | MD | Genetic Counselor (M.S.) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455408000000",
"number": "1073972436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "799 W BOYLSTON ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016063071",
"telephone_number": "774-314-5393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "799 W BOYLSTON ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016063071",
"telephone_number": "774-314-5393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "SHAWNA",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-02-14",
"last_updated": "2016-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MA",
"license": "10176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.