Provider Demographics
NPI:1770468936
Name:WAHLEITHNER, GILLIAN (OTR/L, OTD)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:WAHLEITHNER
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FELIX ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4835
Mailing Address - Country:US
Mailing Address - Phone:303-241-1265
Mailing Address - Fax:
Practice Address - Street 1:111 MADRONE ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2714
Practice Address - Country:US
Practice Address - Phone:831-457-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist