Provider Demographics
NPI:1386764264
Name:GILLMAN, BARBARA ANN (DT)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61275-9520
Mailing Address - Country:US
Mailing Address - Phone:309-269-3943
Mailing Address - Fax:309-496-2001
Practice Address - Street 1:905 17TH ST
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:IL
Practice Address - Zip Code:61275-9520
Practice Address - Country:US
Practice Address - Phone:309-269-3943
Practice Address - Fax:309-496-2001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist