Provider Demographics
NPI:1962960781
Name:GILISON, CARA REBECCA (OTR/L)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:REBECCA
Last Name:GILISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3741
Mailing Address - Country:US
Mailing Address - Phone:904-540-5853
Mailing Address - Fax:904-781-8191
Practice Address - Street 1:4246 W HIGHWAY 318
Practice Address - Street 2:
Practice Address - City:CITRA
Practice Address - State:FL
Practice Address - Zip Code:32113-2141
Practice Address - Country:US
Practice Address - Phone:904-540-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty