Provider Demographics
NPI:1467778647
Name:ZONDERVAN, JILL MILES (OTR)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MILES
Last Name:ZONDERVAN
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 1:1850 COMSTOCK LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1706
Mailing Address - Country:US
Mailing Address - Phone:408-371-8129
Mailing Address - Fax:
Practice Address - Street 1:1850 COMSTOCK LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1706
Practice Address - Country:US
Practice Address - Phone:408-371-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3868225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation