Individual
JENNIFER ELIZABETH O'SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1369 MONMOUTH ST, INDEPENDENCE, OR 97351-1126
(503) 507-0977
Mailing address
16400 ELLENDALE RD, DALLAS, OR 97338-9665
(503) 507-0977
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-AT-1000383
OR
Other
Enumeration date
04/10/2020
Last updated
04/10/2020
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