Provider Demographics
NPI:1467882282
Name:GILLEN, WILLIAM LEE JR (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEE
Last Name:GILLEN
Suffix:JR
Gender:M
Credentials:COTA/L
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Mailing Address - Street 1:111 W MICHIGAN ST FL 9
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2903
Mailing Address - Country:US
Mailing Address - Phone:414-908-8781
Mailing Address - Fax:414-918-2573
Practice Address - Street 1:1883 SHUMWAY HILL RD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6840
Practice Address - Country:US
Practice Address - Phone:570-724-5270
Practice Address - Fax:570-724-5276
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOP007219224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant