Provider Demographics
NPI:1407856008
Name:HURLEY, JILL (COTR,CHT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:COTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 KALISTE SALOOM RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7164
Mailing Address - Country:US
Mailing Address - Phone:337-981-4053
Mailing Address - Fax:337-981-2448
Practice Address - Street 1:2727 KALISTE SALOOM RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7151
Practice Address - Country:US
Practice Address - Phone:337-981-4053
Practice Address - Fax:337-981-2448
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ11784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist