Provider Demographics
NPI:1033093406
Name:GILLAM, SOPHIA THEODORA ANN
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:THEODORA ANN
Last Name:GILLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3197
Mailing Address - Country:US
Mailing Address - Phone:703-291-1254
Mailing Address - Fax:
Practice Address - Street 1:7051 HEATHCOTE VILLAGE WAY STE 105
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3197
Practice Address - Country:US
Practice Address - Phone:703-291-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist