Provider Demographics
NPI:1336599810
Name:GULLIFOR, KATERI LYNNE (DT)
Entity type:Individual
Prefix:
First Name:KATERI
Middle Name:LYNNE
Last Name:GULLIFOR
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKES
Mailing Address - State:WI
Mailing Address - Zip Code:53181-9235
Mailing Address - Country:US
Mailing Address - Phone:815-575-1512
Mailing Address - Fax:
Practice Address - Street 1:1950 SUNSET DR
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9235
Practice Address - Country:US
Practice Address - Phone:815-575-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist