MEDICARE: GILLIAN WAHLEITHNER OTR/L, OTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	28022	CA

General Provider Information

NPI Number	:	1770468936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILLIAN WAHLEITHNER OTR/L, OTD

Provider Business Mailing Address
First Line	:	105 FELIX ST APT 2
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-4835
Country	:	US
Telephone Number	:	303-241-1265
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 MADRONE ST
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2714
Country	:	US
Telephone Number	:	831-457-7057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2025
Last Update Date	:	08/07/2025

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