Provider Demographics
NPI:1053472787
Name:STRANDQUIST, JILL ANNETTE (OTR)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANNETTE
Last Name:STRANDQUIST
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:HANSEN BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 6246
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424
Mailing Address - Country:US
Mailing Address - Phone:970-547-1288
Mailing Address - Fax:970-547-1289
Practice Address - Street 1:0237 GOLDENVIEW DRIVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:970-547-1288
Practice Address - Fax:970-547-1289
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AA238451225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0346463OtherSP SERVICES LICENSE
AA238451OtherNATIONAL BOARD FOR CERTIF