Basic Information
| Provider Information | |||||||||
| NPI: | 1427171347 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEVERINO | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 N PEMBROKE RD | ||||||||
| Address2: | |||||||||
| City: | EPSOM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032344010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037369444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2 N PEMBROKE RD | ||||||||
| Address2: | |||||||||
| City: | EPSOM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032344010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037369444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1373 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.