Healthcare Provider Details

I. General information

NPI: 1750601860
Provider Name (Legal Business Name): MARY E. GILLIGAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE SUITE 190
FRISCO CO
80443
US

IV. Provider business mailing address

321 VAIL CIR
DILLON CO
80435-8309
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-6980
  • Fax:
Mailing address:
  • Phone: 970-468-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAA237677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: