Active NPI
Donovan Gillis, COTA
- Occupational Therapy Assistant
- Tallahassee, FL
National Provider Identifier
1366840563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA 13836
- Practice address
- 1800 Miccosukee Commons Dr
Apt 905
Tallahassee, FL 32308-5435 - Phone
- (850) 508-5347
- NPI assigned
- Dec 22, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA 13836 | FL | Primary |
Addresses
Primary practice location
1800 Miccosukee Commons Dr
Apt 905
Tallahassee, FL 32308-5435
Mailing address
1800 Miccosukee Commons Dr
Apt 905
Tallahassee, FL 32308-5435
Phone (850) 508-5347
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA 13836 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419206400000",
"number": "1366840563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 MICCOSUKEE COMMONS DR",
"address_2": "APT 905",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323085435",
"telephone_number": "850-508-5347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 MICCOSUKEE COMMONS DR",
"address_2": "APT 905",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323085435",
"telephone_number": "850-508-5347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "DONOVAN",
"credential": "COTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-22",
"last_updated": "2014-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA 13836",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.