Provider Demographics
NPI:1396779807
Name:GILLIN, JOHN LORIN (OTRL)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LORIN
Last Name:GILLIN
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SOUTHGATE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1413
Mailing Address - Country:US
Mailing Address - Phone:650-985-7588
Mailing Address - Fax:650-985-7589
Practice Address - Street 1:45 SOUTHGATE AVE
Practice Address - Street 2:STE 201
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1413
Practice Address - Country:US
Practice Address - Phone:650-985-7588
Practice Address - Fax:650-985-7589
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8688225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand