Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 107391 | TX |
NPI | 1134399900 |
---|---|
Provider Name | Mr. Christopher John Gillis |
First Address | San Antonio, TX 78212-2824 |
Second Address | San Antonio, TX 78228-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 02/04/2008 |