Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 000779-1 | NY |
NPI | 1164496931 |
---|---|
Provider Name | Ms. Joan Lucille Sullivan |
First Address | South Nyack, NY 10960-4734 |
Second Address | Valhalla, NY 10595-1503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 16/12/2010 |