Provider Demographics
NPI:1346613890
Name:NORTH, JILLIAN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:NORTH
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1905
Mailing Address - Country:US
Mailing Address - Phone:339-686-2640
Mailing Address - Fax:339-686-2639
Practice Address - Street 1:30 WASHINGTON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1905
Practice Address - Country:US
Practice Address - Phone:339-686-2640
Practice Address - Fax:339-686-2639
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5893225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist