Provider Demographics
NPI:1164261616
Name:MCGILLIS, LAURIN
Entity type:Individual
Prefix:
First Name:LAURIN
Middle Name:
Last Name:MCGILLIS
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 1:622 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5226
Mailing Address - Country:US
Mailing Address - Phone:218-269-6795
Mailing Address - Fax:
Practice Address - Street 1:5300 STINSON AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-6313
Practice Address - Country:US
Practice Address - Phone:218-269-6795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics