Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1420 | NH |
NPI | 1043419294 |
---|---|
Provider Name | Mrs. Laurie Ann Gulla |
First Address | Windham, NH 03087-1303 |
Second Address | Windham, NH 03087-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2007 |
Last Update Date | 23/10/2007 |