MEDICARE: CORYELL AUTISM CENTER

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
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1861162034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORYELL AUTISM CENTER

Provider Business Mailing Address
First Line	:	PO BOX 1858
Second Line	:
City	:	SOQUEL
State	:	CA
Zip	:	95073-2450
Country	:	US
Telephone Number	:	831-291-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 MERRILL RD
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95003
Country	:	US
Telephone Number	:	831-291-7464
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIANNE SULLIVAN
Credential	:
Telephone Number	:	831-291-7464

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	03/13/2026

Similar Medicare Providers

1659375475 — PETER ROTHSCHILD M.D.
Practice Location Address:

724 VIA PALO ALTO STE 5
APTOS, CA
95003-5629

Practice Phone: 510-604-0700
Practice Fax:

1013916980 — DR. JEFF RANDALL PERKINS D.D.S.
Practice Location Address:

9061 SOQUEL DR
APTOS, CA
95003-4001

Practice Phone: 831-688-3633
Practice Fax: 831-688-3702

1417945163 — DR. BENJAMIN WAYNE POPILSKY O.D.
Practice Location Address:

7551 SOQUEL DR
APTOS, CA
95003-3815

Practice Phone: 831-688-2020
Practice Fax: 831-688-2036

1851370902 — SUSAN BORBA MD
Practice Location Address:

7600 OLD DOMINION COURT
APTOS, CA
95003-3821

Practice Phone: 831-458-6200
Practice Fax:

1477533313 — RONNING PHYSICAL THERAPY, INC.
Practice Location Address:

2505 CABRILLO COLLEGE DR
APTOS, CA
95003-3166

Practice Phone: 831-464-3901
Practice Fax: 831-464-3010

1215917026 — MS. MARY VIRGINIA KEELY R.P.T.
Practice Location Address:

2505 CABRILLO COLLEGE DR , C
APTOS, CA
95003-3166

Practice Phone: 831-464-3901
Practice Fax: 831-464-3010

Directions to “CORYELL AUTISM CENTER ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.