Provider Demographics
NPI:1679366967
Name:GULLEDGE, LILLIAN MARGARET (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARGARET
Last Name:GULLEDGE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28328 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-3838
Mailing Address - Country:US
Mailing Address - Phone:936-714-5818
Mailing Address - Fax:
Practice Address - Street 1:28328 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-3838
Practice Address - Country:US
Practice Address - Phone:936-714-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU1-0001834225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist