Provider Demographics
NPI:1144383878
Name:SULLIVAN, CORIE (OT)
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-1750
Mailing Address - Fax:833-627-5148
Practice Address - Street 1:301 RIVERVIEW AVE STE 400
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-1750
Practice Address - Fax:833-627-5148
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000752225X00000X
MD04650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist