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1003047812
ANDY JOE GILLUM
PORTSMOUTH, OH
NPI
1003047812
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: OH OTA . 04143)
Enumeration Date
2009-07-29
Last Update Date
2009-07-29
Business Address
Mr. ANDY JOE GILLUM COTA
2125 ROYCE ST
PORTSMOUTH, OH 45662-4714
Phone number: 740-876-9232
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Mailing Address
Mr. ANDY JOE GILLUM COTA
2125 ROYCE ST
PORTSMOUTH, OH 45662-4714
Phone number: 740-876-9232
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