Individual
MR. CHAD ELLERY GILLHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1510 BYRUM RD, BLYTHEVILLE, AR 72315-8033
(870) 532-2600
Mailing address
4587 CTY RD 670, BROSELEY, MO 63932
(573) 328-4471
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A504
AR
Other
Enumeration date
11/15/2007
Last updated
11/15/2007
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