Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT5695 | CA |
NPI | 1992007215 |
---|---|
Provider Name | Carrie Marie Sullivan |
First Address | San Leandro, CA 94577-3817 |
Second Address | Berkeley, CA 94702-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2010 |
Last Update Date | 18/11/2010 |