Provider Demographics
NPI:1396240602
Name:GULLICKSON, TAYLOR JONES (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JONES
Last Name:GULLICKSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:JONES
Other - Last Name:GULLICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:134 JOHN LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-6332
Mailing Address - Country:US
Mailing Address - Phone:704-883-6446
Mailing Address - Fax:
Practice Address - Street 1:400 WEBBER RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2400
Practice Address - Country:US
Practice Address - Phone:864-579-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
SC225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist