Individual
CASEY ELIZABETH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2545 24TH ST, ROCK ISLAND, IL 61201-5305
(309) 788-0458
Mailing address
2545 24TH ST, ROCK ISLAND, IL 61201-5305
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056010748
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056010748
IL OCCUPATIONAL THERAPY LICENSE NUMBER
IL
01
—
330341
NBCOT
—
Enumeration date
11/01/2014
Last updated
11/01/2014
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