Active NPI
Kimberly Gillis, OTR-L
- Occupational Therapist
- Woburn, MA
National Provider Identifier
1902019136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 012992-1
- Practice address
- 400 W Cummings Park
Suite 3950
Woburn, MA 01801-6519 - Phone
- (800) 451-9101
- Fax
- (781) 933-2828
- NPI assigned
- May 7, 2007
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225X00000X | 012992-1 | NY | Primary |
Addresses
Primary practice location
400 W Cummings Park
Suite 3950
Woburn, MA 01801-6519
Mailing address
3 Middle Rd
High Falls, NY 12440-5012
Phone (845) 687-4181
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 |
|---|---|---|---|
| 012992-1 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902019136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MIDDLE RD",
"city": "HIGH FALLS",
"state": "NY",
"postal_code": "124405012",
"telephone_number": "845-687-4181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 W CUMMINGS PARK",
"address_2": "SUITE 3950",
"city": "WOBURN",
"state": "MA",
"postal_code": "018016519",
"telephone_number": "800-451-9101",
"fax_number": "781-933-2828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "KIMBERLY",
"name_prefix": "Mrs.",
"credential": "OTR-L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "012992-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.