Provider Demographics
NPI:1477085710
Name:DOUGLASS, JILLIAN (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 REDSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4354
Mailing Address - Country:US
Mailing Address - Phone:440-554-6180
Mailing Address - Fax:
Practice Address - Street 1:30 ROTHROCK LOOP
Practice Address - Street 2:STE B
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1331
Practice Address - Country:US
Practice Address - Phone:330-666-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT007734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist