Provider Demographics
NPI:1871395103
Name:CARR, GAYLISA L (PRS)
Entity type:Individual
Prefix:
First Name:GAYLISA
Middle Name:L
Last Name:CARR
Suffix:
Gender:
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 CUSHING DR APT D
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3233
Mailing Address - Country:US
Mailing Address - Phone:216-299-6178
Mailing Address - Fax:216-299-6178
Practice Address - Street 1:3644 CUSHING DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3234
Practice Address - Country:US
Practice Address - Phone:216-299-6178
Practice Address - Fax:216-299-6178
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS004257175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist