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NPI Code Detail

MEDICARE: KELLY SULLIVAN

MEDICARE: KELLY SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1477010528
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SULLIVAN
Provider Business Mailing Address
First Line : 555 E MAPLE AVE
Second Line :
City : WOODBRIDGE
State : NJ
Zip : 07095-3039
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 21 PINE ST
Second Line :
City : ROCKAWAY
State : NJ
Zip : 07866-3130
Country : US
Telephone Number : 973-626-2234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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Directions to “ KELLY SULLIVAN ” Practice Location

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