Provider Demographics
NPI:1134588809
Name:GULLEY, MEGAN I
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:GULLEY
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:SHAWNEETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62984-0180
Mailing Address - Country:US
Mailing Address - Phone:618-313-0992
Mailing Address - Fax:618-252-4706
Practice Address - Street 1:5470 MOUNT MORIAH RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-4077
Practice Address - Country:US
Practice Address - Phone:618-313-0992
Practice Address - Fax:618-252-4706
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist