Provider Demographics
NPI:1326605791
Name:METCALF, JILL LYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:LYN
Last Name:METCALF
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LYN
Other - Last Name:WEISENMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-0410
Mailing Address - Country:US
Mailing Address - Phone:240-625-5176
Mailing Address - Fax:
Practice Address - Street 1:260 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-6345
Practice Address - Country:US
Practice Address - Phone:304-822-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1420224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant