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General NPI Number Information
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NPI Number | 1336704998
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Entity Type | Individual
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Provider Name | MARY SULLIVAN ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2399 ARIEL ST N STE A
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City | MAPLEWOOD
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State | MN
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Zip | 55109-2202
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Country | US
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Telephone | 651-773-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 7932 BOWMAN AVE
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-2903
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Country | US
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Telephone | 651-328-1208
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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