Provider Demographics
NPI:1841968237
Name:GILDENER-GILLIAT, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GILDENER-GILLIAT
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:LIFELONG REHAB NEW ENGLAND INC
Mailing Address - Street 2:290 TURNPIKE RD, SUITE 5-326
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:914-619-0479
Mailing Address - Fax:
Practice Address - Street 1:290 TURNPIKE RD STE 5-326
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2843
Practice Address - Country:US
Practice Address - Phone:914-619-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14007225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist