Individual
GAYLE E. FULKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
734 E MICHIGAN ST, OTTAWA, IL 61350-2412
(815) 431-9260
(815) 431-9260
Mailing address
734 E MICHIGAN ST, OTTAWA, IL 61350-2412
(815) 431-9260
(815) 431-9260
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/20/2007
Last updated
07/08/2007
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