Provider Demographics
NPI:1760268957
Name:GULLIVER, KYLEE E (ATC)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:E
Last Name:GULLIVER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 VOICE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649-9792
Mailing Address - Country:US
Mailing Address - Phone:231-499-9080
Mailing Address - Fax:
Practice Address - Street 1:4000 WHITING DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2398
Practice Address - Country:US
Practice Address - Phone:989-837-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010027482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer