Individual
MRS. ANITA BLISS GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,LOTR
Contact information
Practice address
1213 CAPILANO DR, SHREVEPORT, LA 71106-8286
(318) 797-6492
(318) 797-3304
Mailing address
1213 CAPILANO DR, SHREVEPORT, LA 71106-8286
(318) 797-6492
(318) 797-3304
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
Z10042
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1307874
—
LA
Enumeration date
04/06/2007
Last updated
07/09/2007
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