Healthcare Provider Details

I. General information

NPI: 1316882087
Provider Name (Legal Business Name): WILLIAM GILLIS OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STEWART RD
MONROE MI
48162-5304
US

IV. Provider business mailing address

35058 WINDSOR DR
NEW BALTIMORE MI
48047-4376
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201010107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: