Provider Demographics
NPI:1386773570
Name:GABBARD, LILLIAN RENEE
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:RENEE
Last Name:GABBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:74 TIMBERLINE ESTATES
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-2439
Mailing Address - Country:US
Mailing Address - Phone:606-424-3984
Mailing Address - Fax:606-263-6206
Practice Address - Street 1:74 TIMBERLINE EST
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653
Practice Address - Country:US
Practice Address - Phone:606-424-3984
Practice Address - Fax:606-263-6206
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty