Healthcare Provider Details

I. General information

NPI: 1962099721
Provider Name (Legal Business Name): KELLY W GULICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6391 LANCASTER RD
HEBRON OH
43025-9779
US

IV. Provider business mailing address

6391 LANCASTER RD
HEBRON OH
43025-9779
US

V. Phone/Fax

Practice location:
  • Phone: 740-403-4994
  • Fax:
Mailing address:
  • Phone: 740-403-4994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: