Provider Demographics
NPI:1477114015
Name:GRABAU, JILLIAN CLAIRE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:CLAIRE
Last Name:GRABAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:JILLIAN
Other - Middle Name:CLAIRE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2218 E MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3753
Mailing Address - Country:US
Mailing Address - Phone:414-828-8968
Mailing Address - Fax:
Practice Address - Street 1:8901 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2409
Practice Address - Country:US
Practice Address - Phone:414-328-6640
Practice Address - Fax:414-328-8551
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6251-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist