Provider Demographics
NPI:1356141733
Name:SULLIVAN, MADELYNN ROSE
Entity type:Individual
Prefix:
First Name:MADELYNN
Middle Name:ROSE
Last Name:SULLIVAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11559 TOWNSHIP ROAD 88
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43148-9601
Mailing Address - Country:US
Mailing Address - Phone:740-405-2304
Mailing Address - Fax:
Practice Address - Street 1:11559 TOWNSHIP ROAD 88
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:OH
Practice Address - Zip Code:43148-9601
Practice Address - Country:US
Practice Address - Phone:740-405-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist