Provider Demographics
NPI:1821139049
Name:GILLARD, KRISTIN KAY (OT RL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:KAY
Last Name:GILLARD
Suffix:
Gender:F
Credentials:OT RL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E RIVER RD NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-5407
Mailing Address - Country:US
Mailing Address - Phone:507-258-3287
Mailing Address - Fax:507-258-3288
Practice Address - Street 1:3520 E RIVER RD NE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-5407
Practice Address - Country:US
Practice Address - Phone:507-258-3287
Practice Address - Fax:507-258-3288
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103227225XM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health