Provider Demographics
NPI:1376798827
Name:DAVIS, JILL (OTR)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WEST 83RD STREET
Mailing Address - Street 2:#5C
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 W 83RD ST
Practice Address - Street 2:#5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4909
Practice Address - Country:US
Practice Address - Phone:212-580-4275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012918-1171W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174400000XOther Service ProvidersSpecialist