Provider Demographics
NPI:1508022815
Name:RUPERT, JILL N
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:RUPERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 E WESTVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3813
Mailing Address - Country:US
Mailing Address - Phone:509-467-5626
Mailing Address - Fax:509-465-1736
Practice Address - Street 1:1224 E WESTVIEW CT
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3813
Practice Address - Country:US
Practice Address - Phone:509-467-5626
Practice Address - Fax:509-465-1736
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004505225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist