Healthcare Provider Details

I. General information

NPI: 1386764264
Provider Name (Legal Business Name): BARBARA ANN GILLMAN DT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 17TH ST
PORT BYRON IL
61275-9520
US

IV. Provider business mailing address

905 17TH ST
PORT BYRON IL
61275-9520
US

V. Phone/Fax

Practice location:
  • Phone: 309-269-3943
  • Fax: 309-496-2001
Mailing address:
  • Phone: 309-269-3943
  • Fax: 309-496-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: