Provider Demographics
NPI:1487842944
Name:O'SULLIVAN, RICHARD M (CP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2531
Mailing Address - Country:US
Mailing Address - Phone:530-605-4292
Mailing Address - Fax:530-605-4296
Practice Address - Street 1:2147 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2531
Practice Address - Country:US
Practice Address - Phone:530-605-4292
Practice Address - Fax:530-605-4296
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist