NPIMap

Individual provider Active NPI

Amanda Sullivan, OTR

  • Occupational Therapist
  • Baltimore, MD
National Provider Identifier
1386207462
Registry record updated Apr 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
08428 Issued in MD
Practice address
6811 Campfield Rd
Baltimore, MD 21207-4657
Phone
(410) 486-4573
Fax
(443) 471-0105
NPI assigned
Apr 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 08428 MD Primary

Addresses

Primary practice location

6811 Campfield Rd
Baltimore, MD 21207-4657

Mailing address

109 Woodbrook LN
Baltimore, MD 21212-1035
Phone (908) 216-3193

Other identifiers 1

IdentifierTypeStateIssuer
08428MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address assistedrehab@comcast.net Other

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

LicenseStateTypeSpecialty
08428MDMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Assisted Rehab. Incorporated Occupational Therapist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1555286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555286400000",
    "number": "1386207462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WOODBROOK LN",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212121035",
            "telephone_number": "908-216-3193",
            "fax_number": "214-305-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6811 CAMPFIELD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212074657",
            "telephone_number": "410-486-4573",
            "fax_number": "443-471-0105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "AMANDA",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-15",
        "last_updated": "2019-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MD",
            "license": "08428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08428",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "assistedrehab@comcast.net",
            "affiliation": "N",
            "endpointDescription": "emaill address",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "address",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "home address",
            "address_1": "508 Branch Ave",
            "city": "Little Silver",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "077391111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; 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.