Provider Demographics
NPI:1003598905
Name:GATES, LILLIAN MERRILL (OTR/L)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MERRILL
Last Name:GATES
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MINISTERIAL RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-1318
Mailing Address - Country:US
Mailing Address - Phone:401-741-8056
Mailing Address - Fax:
Practice Address - Street 1:2000 MINISTERIAL RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-1318
Practice Address - Country:US
Practice Address - Phone:401-741-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIOT02185225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist