Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 137496 | KY |
NPI | 1548793573 |
---|---|
Provider Name | Ms. Toshia Donyelle Sullivan |
First Address | Paducah, KY 42001-9678 |
Second Address | Paducah, KY 42001-9678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 06/04/2017 |