Individual
CARISA JANE GULLEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
524 W MAIN ST, DECATURVILLE, TN 38329-8101
(731) 852-3591
(731) 852-2283
Mailing address
2877 MCKENZIE RD, PARSONS, TN 38363-3413
(731) 847-6731
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1257
TN
Other
Enumeration date
10/23/2006
Last updated
02/07/2019
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