Provider Demographics
NPI:1346743465
Name:BARTSCH, JILLIAN LEE (OTR)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LEE
Last Name:BARTSCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LEE
Other - Last Name:SCHAIBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4118 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4118 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3605
Practice Address - Country:US
Practice Address - Phone:616-827-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
MI5201008189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist