Provider Demographics
NPI:1568089001
Name:BALL, JILLIAN INGRID (OTR/L)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:INGRID
Last Name:BALL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1623
Mailing Address - Country:US
Mailing Address - Phone:203-500-8857
Mailing Address - Fax:
Practice Address - Street 1:100 BEARD SAWMILL RD STE 282
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6175
Practice Address - Country:US
Practice Address - Phone:475-239-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5381225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist