Provider Demographics
NPI:1831220995
Name:MCGILLIARD, CAROL COLE (BA, BS, CERTIFICATE)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:COLE
Last Name:MCGILLIARD
Suffix:
Gender:F
Credentials:BA, BS, CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 KIMBALL DR
Mailing Address - Street 2:STE. D-403
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5137
Mailing Address - Country:US
Mailing Address - Phone:253-851-3874
Mailing Address - Fax:253-858-3856
Practice Address - Street 1:6659 KIMBALL DR
Practice Address - Street 2:SUITE D-403
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5137
Practice Address - Country:US
Practice Address - Phone:253-851-3874
Practice Address - Fax:253-858-3856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00000170225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7681745Medicare ID - Type UnspecifiedMEDICARE