Individual
NICOLETTE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
309 CRENSHAW CT, CAMILLUS, NY 13031-2041
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
69933
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69933
NCTRC
—
Enumeration date
09/11/2017
Last updated
09/11/2017
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