MEDICARE: IRENE GILLILAND

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

General Provider Information

NPI Number	:	1871012591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE GILLILAND

Provider Business Mailing Address
First Line	:	5100 GARFIELD AVE APT 10
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3831
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 LARKIN RD
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-9599
Country	:	US
Telephone Number	:	530-695-8020
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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Directions to “ IRENE GILLILAND ” Practice Location

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