Provider Demographics
NPI:1467691584
Name:FORD, JILL ANN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:FORD
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 1:16051 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5605
Mailing Address - Country:US
Mailing Address - Phone:708-226-3090
Mailing Address - Fax:170-822-6300
Practice Address - Street 1:16051 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5605
Practice Address - Country:US
Practice Address - Phone:708-226-3090
Practice Address - Fax:170-822-6300
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057.001858225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist