Provider Demographics
NPI:1427203637
Name:DAVIS, JILL R (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 COUNTY ROUTE 25
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5716
Mailing Address - Country:US
Mailing Address - Phone:315-561-6277
Mailing Address - Fax:315-342-9599
Practice Address - Street 1:379 KLOCKS CORNERS RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6141
Practice Address - Country:US
Practice Address - Phone:315-561-6277
Practice Address - Fax:315-342-9599
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics