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Individual

MISS JACQUELINE MARIE SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
609 CANTON ST, OGDENSBURG, NY 13669-3811
(315) 393-1018
(315) 393-1075
Mailing address
609 CANTON STREET, OGDENSBURG, NY 13669-0000
(315) 393-1019
(315) 393-1075

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
021153
NY

Other

Enumeration date
01/08/2009
Last updated
01/08/2009
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