Active NPI
Elisa O Sullivan
- Occupational Therapist
- Melrose Park, IL
National Provider Identifier
1225362007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 056001600
- Practice address
- 701 W North Ave
Rehab Services/Therapy
Melrose Park, IL 60160-1612 - Phone
- (708) 681-3200
- NPI assigned
- Sep 25, 2009
- Sex
- Female
- Sole proprietor
- No
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 | 056001600 | IL | Primary |
Addresses
Primary practice location
701 W North Ave
Rehab Services/Therapy
Melrose Park, IL 60160-1612
Mailing address
701 W North Ave
Rehab Services/Therapy
Melrose Park, IL 60160-1612
Phone (708) 681-3200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 056001600 | Other | IL | OT STATE LICENSE |
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 |
|---|---|---|---|
| 056001600 | IL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253836800000",
"number": "1225362007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 W NORTH AVE",
"address_2": "REHAB SERVICES/THERAPY",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601601612",
"telephone_number": "708-681-3200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 W NORTH AVE",
"address_2": "REHAB SERVICES/THERAPY",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601601612",
"telephone_number": "708-681-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ELISA",
"middle_name": "O",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-09-25",
"last_updated": "2009-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": "056001600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OT STATE LICENSE",
"identifier": "056001600",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.