Provider Demographics
NPI:1548564933
Name:ZACCARELLA, JILLIAN MARIE (LMT, COSMOTOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:MARIE
Last Name:ZACCARELLA
Suffix:
Gender:F
Credentials:LMT, COSMOTOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 HILLVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1810
Mailing Address - Country:US
Mailing Address - Phone:716-348-4743
Mailing Address - Fax:
Practice Address - Street 1:105 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1522
Practice Address - Country:US
Practice Address - Phone:716-348-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist