Individual
MS. OTHRESSA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRANIAL PROTHESIS SP
Contact information
Practice address
15606 WOODLAWN EAST AVE, SOUTH HOLLAND, IL 60473-1834
(630) 251-3838
Mailing address
15606 WOODLAWN EAST AVE, SOUTH HOLLAND, IL 60473-1834
(630) 251-3838
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
03/24/2025
Last updated
03/24/2025
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