Individual
MARIBROOKE JEANANNE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
896 GAULT TERRY RD, UPTON, KY 42784-9204
(270) 537-5600
Mailing address
896 GAULT TERRY RD, UPTON, KY 42784-9204
(270) 537-5600
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
920625518
KY
Other
Enumeration date
11/22/2022
Last updated
03/06/2024
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