Jacqueline Marie Sullivan, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

021153 Issued in NY

Practice address

609 Canton St
Ogdensburg, NY 13669-3811

Phone

(315) 393-1018

Fax

(315) 393-1075

NPI assigned

Jan 8, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231372800000",
    "number": "1023255395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 CANTON STREET",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136690000",
            "telephone_number": "315-393-1019",
            "fax_number": "315-393-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 CANTON ST",
            "city": "OGDENSBURG",
            "state": "NY",
            "postal_code": "136693811",
            "telephone_number": "315-393-1018",
            "fax_number": "315-393-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JACQUELINE",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-08",
        "last_updated": "2009-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "021153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol Lee Stevens, RN
• Alana M Stevenson, FNP-C
• Robert Arthur Stickles, LCSW
• Martha Jane Stiles, RN
• Brandy Streeter
• Janae Dymon Sweet
• Christina Ann Sylver, LMSW
• Anola Tanga, M.D.
• Ramasubba Rao Tatini, M.D.
• Emily Teneyck, DPT

• Massage Therapist in Ogdensburg, NY
• Providers in Ogdensburg, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.