Individual
JENNIFER SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
82884 N PACIFIC HWY, CRESWELL, OR 97426-9407
(541) 514-0131
Mailing address
82884 N PACIFIC HWY, CRESWELL, OR 97426-9407
(541) 514-0131
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
24449
OR
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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