MEDICARE: MS. AUDREY GILLIAM OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	03105	MD
2	225X00000X	Occupational Therapist	OT540	DC

General Provider Information

NPI Number	:	1083885230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY GILLIAM OTR/L

Provider Business Mailing Address
First Line	:	601 PENNSYLVANIA AVE.
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 PENNSYLVANIA AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20004-2601
Country	:	US
Telephone Number	:	301-204-9130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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