Provider Demographics
NPI:1962079327
Name:O'SULLIVAN, PATRICK T (ATC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:O'SULLIVAN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3444
Mailing Address - Country:US
Mailing Address - Phone:401-255-3980
Mailing Address - Fax:
Practice Address - Street 1:1150 DOUGLAS PIKE
Practice Address - Street 2:ATHLETIC TRAINING
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-0291
Practice Address - Country:US
Practice Address - Phone:401-232-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT001812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer