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General NPI Number Information
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NPI Number | 1700468071
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Entity Type | Individual
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Provider Name | CASSANDRA GULLETT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 2676 COUNTY ROAD 195
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City | CLYDE
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State | OH
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Zip | 43410-9549
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Country | US
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Telephone | 419-603-1302
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Fax |
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Provider Business Mailing Address
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Address Line | 142 LIBERTY ST
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City | CLYDE
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State | OH
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Zip | 43410-1807
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Country | US
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Telephone | 419-202-9693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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