Provider Demographics
NPI:1437272028
Name:SULLIVAN, KATHERINE BETH
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:BETH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 PATCHOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1694
Mailing Address - Country:US
Mailing Address - Phone:631-654-0989
Mailing Address - Fax:
Practice Address - Street 1:88 PATCHOGUE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1694
Practice Address - Country:US
Practice Address - Phone:631-654-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist