Healthcare Provider Details

I. General information

NPI: 1235940461
Provider Name (Legal Business Name): TAYLEIGH MIRANDA SULLIVAN RBT-24-368486
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 W 4TH ST
MARION IN
46952-3549
US

IV. Provider business mailing address

1200 S 4TH AVE LOT 35
JONESBORO IN
46938-1557
US

V. Phone/Fax

Practice location:
  • Phone: 317-572-8793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-368486
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: