Active NPI
Anna Sullivan
- Occupational Therapist
- Portland, OR
National Provider Identifier
1861026759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 433731
- Practice address
- 11855 NE Glenn Widing Dr
Portland, OR 97220-9057 - Phone
- (860) 336-6857
- NPI assigned
- Feb 28, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 20623 | FL | |
| Occupational Therapist | 225X00000X | 433731 | OR | Primary |
Addresses
Primary practice location
11855 NE Glenn Widing Dr
Portland, OR 97220-9057
Mailing address
10715 SW Muirwood Dr
Portland, OR 97225-5216
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 |
|---|---|---|---|
| 433731 | OR | MD | Occupational Therapist |
| 20623 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1861026759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10715 SW MUIRWOOD DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11855 NE GLENN WIDING DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972209057",
"telephone_number": "860-336-6857"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "ANNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-28",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "20623",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "OR",
"license": "433731",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.