Provider Demographics
NPI:1942539143
Name:SULLIVAN, VERONICA CARMELINA (OTR)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:CARMELINA
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:CARMELINA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:346 SPRUCEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6414
Mailing Address - Country:US
Mailing Address - Phone:210-737-4551
Mailing Address - Fax:
Practice Address - Street 1:8700 CROWNHILL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1126
Practice Address - Country:US
Practice Address - Phone:210-684-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115433225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist