Provider Demographics
NPI:1578044897
Name:GILLIS, ESPERANZA NATIVIDAD
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:NATIVIDAD
Last Name:GILLIS
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 1:5813 STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4502
Mailing Address - Country:US
Mailing Address - Phone:214-738-3036
Mailing Address - Fax:
Practice Address - Street 1:2301 MARSH LN # 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8497
Practice Address - Country:US
Practice Address - Phone:972-899-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist