Provider Demographics
NPI:1932182516
Name:GULICK, KRISTIN L (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:GULICK
Suffix:
Gender:F
Credentials:OTR/L, CHT
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 7377
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7377
Mailing Address - Country:US
Mailing Address - Phone:541-633-7535
Mailing Address - Fax:541-706-9036
Practice Address - Street 1:2100 NE NEFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6213
Practice Address - Country:US
Practice Address - Phone:541-633-7535
Practice Address - Fax:541-706-9036
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR914195225XH1200X
WAOT00003451225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0255903OtherWASHINGTON L & I
OR115514Medicaid
OR115514Medicaid
OR00WCNHMGMedicare ID - Type Unspecified
ORR152234Medicare PIN