Provider Demographics
NPI:1235258468
Name:LIVESAY, GILLIAN CROWLEY (MHS, OTRL)
Entity Type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:CROWLEY
Last Name:LIVESAY
Suffix:
Gender:F
Credentials:MHS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8270 WILLOW OAKS CORPORATE DR # 2120
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4511
Mailing Address - Country:US
Mailing Address - Phone:571-423-4864
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:8270 WILLOW OAKS CORPORATE DR # 2120
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4511
Practice Address - Country:US
Practice Address - Phone:571-423-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006827225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
113326OtherHEALTHLINK PROV ID
IL4117OtherHAMP PROVIDER ID
7216OtherPERSONALCARE PROV ID
IL203OtherBLUE CROSS PROV ID
7216OtherPERSONALCARE PROV ID