Provider Demographics
NPI:1962580415
Name:GILMAN, AMY (MS, OTRIL)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:GILMAN
Suffix:
Gender:F
Credentials:MS, OTRIL
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:O'COIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4802 BEECH TREE DRIVE SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461
Mailing Address - Country:US
Mailing Address - Phone:508-637-1138
Mailing Address - Fax:
Practice Address - Street 1:4114 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-343-8988
Practice Address - Fax:508-867-8127
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8810225X00000X
NC13989225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0704580Medicaid
MAAA48978OtherHARVARD PILGRIM
MA0T0156OtherBCBS