Provider Demographics
NPI:1588849053
Name:MCCOLGAN, JILL ELIZABETH (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:MCCOLGAN
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 1:209 AUSTINE DR
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7223
Mailing Address - Country:US
Mailing Address - Phone:802-257-7852
Mailing Address - Fax:
Practice Address - Street 1:2707 PINE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2522
Practice Address - Country:US
Practice Address - Phone:415-563-7600
Practice Address - Fax:415-563-6732
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9741225X00000X
MA09366225X00000X
VT072.0134192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist