Provider Demographics
NPI:1336548809
Name:GILLIAM, LAUREN BAKER (ATC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BAKER
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 WARRENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-9522
Mailing Address - Country:US
Mailing Address - Phone:740-816-3575
Mailing Address - Fax:
Practice Address - Street 1:284 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7616
Practice Address - Country:US
Practice Address - Phone:614-841-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0039372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer