Individual
MARTY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
7801 WOODWAY DR, WOODWAY, TX 76712-3860
(254) 235-7801
Mailing address
PO BOX 768, MEXIA, TX 76667-0768
(903) 644-8058
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216097
TX
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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