Provider Demographics
NPI:1568770493
Name:GILLIAM, JANIS LEE
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:LEE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32121 OLD FORT
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173
Mailing Address - Country:US
Mailing Address - Phone:734-379-6037
Mailing Address - Fax:734-379-2371
Practice Address - Street 1:32121 OLD FORT
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173
Practice Address - Country:US
Practice Address - Phone:734-379-6037
Practice Address - Fax:734-379-2371
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist