Provider Demographics
NPI:1912167354
Name:GORMLEY-GUTTU, HELEN J
Entity type:Individual
Prefix:MS
First Name:HELEN
Middle Name:J
Last Name:GORMLEY-GUTTU
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:GORMLEY-GUTTU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, OTR/L
Mailing Address - Street 1:16177 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7004
Mailing Address - Country:US
Mailing Address - Phone:360-941-0164
Mailing Address - Fax:
Practice Address - Street 1:16177 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-7004
Practice Address - Country:US
Practice Address - Phone:360-941-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001867225X00000X
IL056000835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist