Individual
THERESE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
15802 CEDAR RIDGE CT, GRANGER, IN 46530-6516
(574) 243-2487
Mailing address
15802 CEDAR RIDGE CT, GRANGER, IN 46530-6516
(574) 243-2487
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31004108A
IN
Other
Enumeration date
05/13/2009
Last updated
05/13/2009
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