Provider Demographics
NPI:1326455866
Name:GILLILAND, KATIE ANNE (LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ANNE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANNE
Other - Last Name:PIPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-0921
Mailing Address - Country:US
Mailing Address - Phone:303-328-7828
Mailing Address - Fax:
Practice Address - Street 1:710 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2621
Practice Address - Country:US
Practice Address - Phone:303-328-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist