Provider Demographics
NPI:1972922029
Name:GILLIAM, ADAIR (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ADAIR
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12655 STILL POND LN
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2227
Mailing Address - Country:US
Mailing Address - Phone:703-453-9155
Mailing Address - Fax:
Practice Address - Street 1:12655 STILL POND LN
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:VA
Practice Address - Zip Code:20171-2227
Practice Address - Country:US
Practice Address - Phone:703-453-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist