Provider Demographics
NPI:1346439601
Name:GILES, JAN L (OTA)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:GILES
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 STATE HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-6564
Mailing Address - Country:US
Mailing Address - Phone:903-253-2469
Mailing Address - Fax:
Practice Address - Street 1:303 MURCHISON ST
Practice Address - Street 2:
Practice Address - City:FRANKSTON
Practice Address - State:TX
Practice Address - Zip Code:75763-9721
Practice Address - Country:US
Practice Address - Phone:903-876-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant