Provider Demographics
NPI:1295610269
Name:GILLIAM, SARA LEANN (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:LEANN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 BENTOWN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRUMLEY
Mailing Address - State:MO
Mailing Address - Zip Code:65017-3518
Mailing Address - Country:US
Mailing Address - Phone:573-832-2281
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-348-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029181224Z00000X
2012029181224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty