Individual
BRANDI SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2626 SAINT JOE CENTER RD, FORT WAYNE, IN 46825-5042
(260) 497-0328
Mailing address
9426 LIMA RD, FORT WAYNE, IN 46818-8680
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
32003246A
IN
Other
Enumeration date
12/08/2017
Last updated
11/12/2020
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