Provider Demographics
NPI:1255700670
Name:GILLIS, THOMAS (ATP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GILLIS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 IRWIN LN
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2874
Mailing Address - Country:US
Mailing Address - Phone:207-459-8718
Mailing Address - Fax:
Practice Address - Street 1:7 IRWIN LN
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901-2874
Practice Address - Country:US
Practice Address - Phone:207-459-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEATP14464225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner