Healthcare Provider Details

I. General information

NPI: 1104949098
Provider Name (Legal Business Name): MARIAN GILLARD OTR L. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

IV. Provider business mailing address

530 GENERAL PATTERSON DR
GLENSIDE PA
19038-3202
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-7575
  • Fax:
Mailing address:
  • Phone: 215-576-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC000189L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: