Provider Demographics
NPI:1083016562
Name:SEROWATKA, JILLIAN
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SEROWATKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:CARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8592 OLD LINE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1230
Mailing Address - Country:US
Mailing Address - Phone:267-879-9714
Mailing Address - Fax:
Practice Address - Street 1:3500 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4101
Practice Address - Country:US
Practice Address - Phone:610-359-4421
Practice Address - Fax:610-353-4651
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist