Individual
JENNIFER SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3815 W MASON RD, DEER PARK, WA 99006-9511
(509) 638-7899
Mailing address
3815 W MASON RD, DEER PARK, WA 99006-9511
(509) 638-7899
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OC 60483407
WA
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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