Provider Demographics
NPI:1083032536
Name:RABIDEAU, JILL PERRY (MHA, MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:PERRY
Last Name:RABIDEAU
Suffix:
Gender:F
Credentials:MHA, MS, OTR/L
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MNA, MS, OTR/L
Mailing Address - Street 1:14 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3037
Mailing Address - Country:US
Mailing Address - Phone:508-596-3416
Mailing Address - Fax:
Practice Address - Street 1:14 SHADY OAK LN
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3037
Practice Address - Country:US
Practice Address - Phone:508-596-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist