MEDICARE: MRS. BARBARA ANN GILLMAN DT

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	222Q00000X	Developmental Therapist		IL

General Provider Information

NPI Number	:	1386764264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA ANN GILLMAN DT

Provider Business Mailing Address
First Line	:	905 17TH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9520
Country	:	US
Telephone Number	:	309-269-3943
Fax Number	:	309-496-2001

Provider Business Practice Location Address
First Line	:	905 17TH ST
Second Line	:
City	:	PORT BYRON
State	:	IL
Zip	:	61275-9520
Country	:	US
Telephone Number	:	309-269-3943
Fax Number	:	309-496-2001

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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