Provider Demographics
NPI:1578843587
Name:O'SULLIVAN, PATRICIA C (MED)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:C
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4853
Mailing Address - Country:US
Mailing Address - Phone:630-649-8524
Mailing Address - Fax:630-649-8524
Practice Address - Street 1:3323 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4853
Practice Address - Country:US
Practice Address - Phone:630-649-8523
Practice Address - Fax:630-904-4673
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist