Provider Demographics
NPI:1407502008
Name:DOLCE, JILLIAN ELIZABETH (COTA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:DOLCE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HESELTON DR
Mailing Address - Street 2:
Mailing Address - City:SLATE HILL
Mailing Address - State:NY
Mailing Address - Zip Code:10973-3907
Mailing Address - Country:US
Mailing Address - Phone:845-467-8237
Mailing Address - Fax:
Practice Address - Street 1:65 HESELTON DR
Practice Address - Street 2:
Practice Address - City:SLATE HILL
Practice Address - State:NY
Practice Address - Zip Code:10973-3907
Practice Address - Country:US
Practice Address - Phone:845-467-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011036-01224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant