Provider Demographics
NPI:1497058655
Name:MOTZ, JILL (LMT, CDT, MLDT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MOTZ
Suffix:
Gender:F
Credentials:LMT, CDT, MLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BOGARD RD STE A203
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6569
Mailing Address - Country:US
Mailing Address - Phone:907-727-2596
Mailing Address - Fax:866-735-0985
Practice Address - Street 1:1700 E BOGARD RD STE A203
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-727-2596
Practice Address - Fax:866-735-0985
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist