Brianne Carmela Russ Sullivan, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

006016 Issued in GA

Practice address

300 E Hospital Road
Fort Eisenhower, GA 30905

Phone

(706) 787-8776

NPI assigned

Sep 4, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1386012573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E HOSPITAL ROAD",
            "city": "FT EISENHOWER",
            "state": "GA",
            "postal_code": "30905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E HOSPITAL ROAD",
            "city": "FORT EISENHOWER",
            "state": "GA",
            "postal_code": "30905",
            "telephone_number": "706-787-8776"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3736 Executive Center Dr",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309072360",
            "country_code": "US",
            "telephone_number": "706-426-4200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BRIANNE",
        "middle_name": "CARMELA RUSS",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-04",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "006016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rakesh Kumar Sharma, D.O.
• Stevi Bagwell Shaw, PHARMD
• Dustin Kyle Smith Jr., DMD
• Melissa Jo Sparks, M.D.
• Stephen Spivey, MD
• Shuborna Bonnie Nath Suwan, MD
• Shima Shaikh Syed, M.D.
• Shanieca Taylor
• Tiffany Y Taylor, MD
• Alexandra Telly, PT

• Occupational Therapist in Fort Eisenhower, GA
• Providers in Fort Eisenhower, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.