Provider Demographics
NPI:1467806307
Name:GALEN, JILL ANNETTE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNETTE
Last Name:GALEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:GALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:34 HENRY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:HARPSWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04079-2202
Mailing Address - Country:US
Mailing Address - Phone:207-833-5413
Mailing Address - Fax:
Practice Address - Street 1:15 HASSON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-1613
Practice Address - Country:US
Practice Address - Phone:207-588-7692
Practice Address - Fax:207-588-7693
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist