Individual
MR. ANDY JOE GILLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
2125 ROYCE ST, PORTSMOUTH, OH 45662-4714
(740) 876-9232
(740) 876-9525
Mailing address
2125 ROYCE ST, PORTSMOUTH, OH 45662-4714
(740) 876-9232
(740) 876-9525
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA . 04143
OH
Other
Enumeration date
07/29/2009
Last updated
07/29/2009
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