Provider Demographics
NPI:1891965935
Name:GILLARD, JOAN C
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:GILLARD
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 1:1504 KINGSTREAM CIR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2700
Mailing Address - Country:US
Mailing Address - Phone:703-437-8353
Mailing Address - Fax:
Practice Address - Street 1:1504 KINGSTREAM CIRCLE
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2700
Practice Address - Country:US
Practice Address - Phone:703-505-5771
Practice Address - Fax:703-437-0168
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist