Individual
WILLIAM JOSEPH SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
200 BELLE TERRE RD, PORT JEFFERSON, NY 11777-1928
(631) 474-6264
Mailing address
220 SYRACUSE AVE, MEDFORD, NY 11763-3126
(631) 758-2824
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1052118
NY
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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