Provider Demographics
NPI:1326269432
Name:WELCH, JILL ANN (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:WELCH
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANNE
Other - Last Name:PLOURDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:618 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5935
Mailing Address - Country:US
Mailing Address - Phone:207-795-6110
Mailing Address - Fax:207-795-6189
Practice Address - Street 1:618 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-795-6110
Practice Address - Fax:207-795-6189
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100345OtherANTHEM