Provider Demographics
NPI:1528714607
Name:O'SULLIVAN, MARTIN DANIEL (RRT)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:DANIEL
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 NE 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-5555
Mailing Address - Country:US
Mailing Address - Phone:352-213-8389
Mailing Address - Fax:
Practice Address - Street 1:3219 NE 48TH AVE
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-5555
Practice Address - Country:US
Practice Address - Phone:352-213-8389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-27
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT6638227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered