Provider Demographics
NPI:1558401000
Name:ROESCH, JILL CHRISTINE (MS OTR L)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CHRISTINE
Last Name:ROESCH
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 RIVER POINT RD
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5247
Mailing Address - Country:US
Mailing Address - Phone:314-795-7019
Mailing Address - Fax:
Practice Address - Street 1:208 SHERRY RD
Practice Address - Street 2:
Practice Address - City:LABADIE
Practice Address - State:MO
Practice Address - Zip Code:63055-1042
Practice Address - Country:US
Practice Address - Phone:636-239-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist