Provider Demographics
NPI:1124209770
Name:SHILLING, JILLIAN NICHOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:NICHOLE
Last Name:SHILLING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 LEE ROAD
Mailing Address - Street 2:APT J340
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-740-0316
Mailing Address - Fax:
Practice Address - Street 1:1936 LEE ROAD
Practice Address - Street 2:STE 137
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-644-3737
Practice Address - Fax:407-644-3009
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47725225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist