Provider Demographics
NPI:1558724120
Name:SCHILLO, JESSICA HELEN
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:HELEN
Last Name:SCHILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:HELEN
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 WESTMORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-1319
Mailing Address - Country:US
Mailing Address - Phone:404-889-2436
Mailing Address - Fax:
Practice Address - Street 1:1230 WESTMORELAND AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-1319
Practice Address - Country:US
Practice Address - Phone:404-889-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602400225200000X
CA8799225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant