Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5201010378 | MI |
NPI | 1245707439 |
---|---|
Provider Name | Elizabeth Ann Sullivan |
First Address | Rochester Hills, MI 48309-3124 |
Second Address | Warren, MI 48093-2547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2018 |
Last Update Date | 26/10/2018 |