Provider Demographics
NPI:1104949098
Name:GILLARD, MARIAN (OTR L PHD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:GILLARD
Suffix:
Gender:F
Credentials:OTR L PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 GENERAL PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3202
Mailing Address - Country:US
Mailing Address - Phone:215-576-8315
Mailing Address - Fax:
Practice Address - Street 1:8301 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2006
Practice Address - Country:US
Practice Address - Phone:215-624-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC000189L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAHL1185465OtherLIABILITY INSURANCE POLIC