Healthcare Provider Details

I. General information

NPI: 1972922029
Provider Name (Legal Business Name): ADAIR GILLIAM OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 STILL POND LN
OAK HILL VA
20171-2227
US

IV. Provider business mailing address

12655 STILL POND LN
OAK HILL VA
20171-2227
US

V. Phone/Fax

Practice location:
  • Phone: 703-453-9155
  • Fax:
Mailing address:
  • Phone: 703-453-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119002004
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: