Basic Information
| Provider Information | |||||||||
| NPI: | 1710394754 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | COTA/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21304 WASHER RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT OLIVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620692330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175560113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 UNIVERSITY ST | ||||||||
| Address2: | |||||||||
| City: | CARLINVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626269600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178544433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057.003276 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.