1306037130 NPI number — MRS. MARY A. O'SULLIVAN MS, OTR/L

Table of content: MRS. MARY A. O'SULLIVAN MS, OTR/L (NPI 1306037130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306037130 NPI number — MRS. MARY A. O'SULLIVAN MS, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'SULLIVAN
Provider First Name:
MARY
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, OTR/L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOMASELLO
Provider Other First Name:
MARY
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306037130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
646 E. DELAVAN
Provider Second Line Business Mailing Address:
ROOM 127
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-816-4174
Provider Business Mailing Address Fax Number:
941-359-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
646 E. DELAVAN
Provider Second Line Business Practice Location Address:
ROOM 127
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-816-4174
Provider Business Practice Location Address Fax Number:
941-359-1555
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OT 12835 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000385100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 892350700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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