Provider Demographics
NPI:1497823173
Name:ZORN VELDER, JILL INEZ (MA OTR CHT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:INEZ
Last Name:ZORN VELDER
Suffix:
Gender:F
Credentials:MA OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLONAVOR ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-736-0168
Mailing Address - Fax:
Practice Address - Street 1:1373 BROAD STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-773-4263
Practice Address - Fax:973-773-4336
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00035400225X00000X
NJ9105001250225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
683283Medicare ID - Type Unspecified