Provider Demographics
NPI:1356660674
Name:SULLIVAN, MARGARET LEE (LMT, CMT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3617
Mailing Address - Country:US
Mailing Address - Phone:229-425-9754
Mailing Address - Fax:
Practice Address - Street 1:1801 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3617
Practice Address - Country:US
Practice Address - Phone:229-425-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist