Provider Demographics
NPI:1073185971
Name:GULLA, THERESA LYNN (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:GULLA
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-9710
Mailing Address - Country:US
Mailing Address - Phone:610-762-5714
Mailing Address - Fax:
Practice Address - Street 1:1023 E BALTIMORE PIKE STE 303
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5126
Practice Address - Country:US
Practice Address - Phone:610-449-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist