Provider Demographics
NPI:1285201772
Name:DECUFFA, JILLIAN (ATC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DECUFFA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 POKONOKET RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-1924
Mailing Address - Country:US
Mailing Address - Phone:914-523-6864
Mailing Address - Fax:
Practice Address - Street 1:10 CEDARHILL PARK DR
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2226
Practice Address - Country:US
Practice Address - Phone:914-523-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer