Provider Demographics
NPI:1326284621
Name:OLSEN, JILL M (OT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:M
Last Name:OLSEN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:16 MOREY AVE
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-1146
Mailing Address - Country:US
Mailing Address - Phone:585-335-5329
Mailing Address - Fax:
Practice Address - Street 1:16 MOREY AVE
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1146
Practice Address - Country:US
Practice Address - Phone:585-335-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011713-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist