Individual
KEVIN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7540 N 19TH AVE STE 200, PHOENIX, AZ 85021-7967
(888) 873-4221
Mailing address
7540 N 19TH AVE STE 200, PHOENIX, AZ 85021-7967
(888) 873-4221
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4049
MT
Other
Enumeration date
03/03/2016
Last updated
03/03/2016
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