Provider Demographics
NPI:1578844304
Name:PRIMEAU, JILL MARLISE (OT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARLISE
Last Name:PRIMEAU
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SUFFOLK LN
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1379
Mailing Address - Country:US
Mailing Address - Phone:518-796-0656
Mailing Address - Fax:
Practice Address - Street 1:6110 STATE ROUTE 8
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:NY
Practice Address - Zip Code:12817-2417
Practice Address - Country:US
Practice Address - Phone:518-494-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009341-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist