Provider Demographics
NPI:1932602257
Name:DULL, SALLY ANN (CTRS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:ANN
Last Name:DULL
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8824
Mailing Address - Country:US
Mailing Address - Phone:269-945-1301
Mailing Address - Fax:269-945-5380
Practice Address - Street 1:2700 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-8824
Practice Address - Country:US
Practice Address - Phone:269-945-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
23847OtherNCTRC