Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1487842944 |
---|---|
Provider Name | Richard M O'sullivan |
First Address | Redding, CA 96001-2531 |
Second Address | Redding, CA 96001-2531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2007 |
Last Update Date | 06/02/2013 |