Individual
MRS. AMANDA LEIGH SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC
Contact information
Practice address
8229 CLAYTON RD, SUITE 204, SAINT LOUIS, MO 63117-1155
(314) 721-7325
Mailing address
3205 5 OAKS DR, ARNOLD, MO 63010-3886
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096-001527
IL
2255A2300X
Athletic Trainer
Primary
2004020472
MO
Other
Enumeration date
04/03/2006
Last updated
06/09/2011
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