Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 48.003702 | CT |
NPI | 1003447624 |
---|---|
Provider Name | Leanne Elizabeth Sullivan |
First Address | North Granby, CT 06060-1423 |
Second Address | Westfield, MA 01085-3678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2020 |
Last Update Date | 02/02/2020 |