Provider Demographics
NPI:1902999469
Name:SULLINS, NEVA JOYCE (OTRL)
Entity Type:Individual
Prefix:
First Name:NEVA
Middle Name:JOYCE
Last Name:SULLINS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BALDRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048
Mailing Address - Country:US
Mailing Address - Phone:615-415-4002
Mailing Address - Fax:615-672-0756
Practice Address - Street 1:108 BALDRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048
Practice Address - Country:US
Practice Address - Phone:615-415-4002
Practice Address - Fax:615-672-0756
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R0350171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-R0350OtherOCCUPATIONAL THERAPIST