Provider Demographics
NPI:1811522626
Name:GILLS, LOREN RAYE (COTA/L)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:RAYE
Last Name:GILLS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 HIGHWAY 26 W
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8243
Mailing Address - Country:US
Mailing Address - Phone:870-557-3511
Mailing Address - Fax:
Practice Address - Street 1:159 HIGHWAY 26 W
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8243
Practice Address - Country:US
Practice Address - Phone:870-557-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A1594224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty