Provider Demographics
NPI:1497993448
Name:JORDAN-COLE, JILL MARIE (MA,OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:JORDAN-COLE
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CANTERBURY GATE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2926
Mailing Address - Country:US
Mailing Address - Phone:516-414-8118
Mailing Address - Fax:
Practice Address - Street 1:100 CANTERBURY GATE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2926
Practice Address - Country:US
Practice Address - Phone:917-602-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012209-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist