Provider Demographics
NPI:1275388423
Name:GUNN, KISHA
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:GUNN
Suffix:
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 1:183 E WILSON BRIDGE RD APT B
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2690
Mailing Address - Country:US
Mailing Address - Phone:614-256-5622
Mailing Address - Fax:
Practice Address - Street 1:183 E WILSON BRIDGE RD APT B
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2690
Practice Address - Country:US
Practice Address - Phone:614-256-5622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH42482225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist