Provider Demographics
NPI:1275954414
Name:PITTARD, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:PITTARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CENTRAL EXPY S
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8062
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:214-382-0943
Practice Address - Street 1:1101 CENTRAL EXPY S
Practice Address - Street 2:SUITE 185
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8062
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:214-382-0943
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113430225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist