Provider Demographics
NPI:1508930041
Name:COWAN, JILL DILLON (OTR L)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:DILLON
Last Name:COWAN
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:DILLON
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3939 TAMBOR RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-3407
Mailing Address - Country:US
Mailing Address - Phone:858-292-8858
Mailing Address - Fax:858-292-0878
Practice Address - Street 1:5814 VAN ALLEN WAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7358
Practice Address - Country:US
Practice Address - Phone:760-438-4466
Practice Address - Fax:760-432-7218
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7189225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist