Healthcare Provider Details

I. General information

NPI: 1821139049
Provider Name (Legal Business Name): KRISTIN KAY GILLARD OT RL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E RIVER RD NE
ROCHESTER MN
55906-5407
US

IV. Provider business mailing address

3520 E RIVER RD NE
ROCHESTER MN
55906-5407
US

V. Phone/Fax

Practice location:
  • Phone: 507-258-3287
  • Fax: 507-258-3288
Mailing address:
  • Phone: 507-258-3287
  • Fax: 507-258-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number103227
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: