Healthcare Provider Details

I. General information

NPI: 1881559961
Provider Name (Legal Business Name): HEATHER SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 N MUSKOGEE PL
CLAREMORE OK
74017-3058
US

IV. Provider business mailing address

15459 WILL LN
SKIATOOK OK
74070-4941
US

V. Phone/Fax

Practice location:
  • Phone: 918-855-8603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1534
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: