Provider Demographics
NPI:1083733844
Name:SHUTER, JILL (MOT, OTRL)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SHUTER
Suffix:
Gender:F
Credentials:MOT, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 GLEN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1285
Mailing Address - Country:US
Mailing Address - Phone:954-654-8054
Mailing Address - Fax:
Practice Address - Street 1:2092 AYRSLEY TOWN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4037
Practice Address - Country:US
Practice Address - Phone:704-577-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10475225XP0200X
FLOT12620225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics