Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT60444643 | WA |
N | 225XH1200X | Occupational Therapist - Hand | TL 60442903 | WA |
NPI | 1194149443 |
---|---|
Provider Name | Mrs. Jayme Kristina Gilliam |
First Address | Spokane, WA 99223-6678 |
Second Address | Spokane, WA 99223-6678 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 05/04/2021 |