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Individual

MATTHEW SULLIVAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
500 VALLE VISTA DR, ATHENS, TX 75751-2760
(903) 675-2046
Mailing address
7401 ROMANS RD, ATHENS, TX 75751-8449

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
214230
TX

Other

Enumeration date
08/24/2018
Last updated
08/24/2018
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