Individual
ELIZABETH ANNE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Mailing address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
(574) 247-9442
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31006976A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31006976A
INDIANA PROFESSIONAL LICENSE
IN
Enumeration date
08/28/2019
Last updated
08/28/2019
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