Provider Demographics
NPI:1598034290
Name:TROMBETTA, JILLIAN PAIGE (MSOT/L)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:PAIGE
Last Name:TROMBETTA
Suffix:
Gender:F
Credentials:MSOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ALEXANDRA PARK DR
Mailing Address - Street 2:APARTMENT 301
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1577
Mailing Address - Country:US
Mailing Address - Phone:732-757-5112
Mailing Address - Fax:
Practice Address - Street 1:1289 OLIVER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4450
Practice Address - Country:US
Practice Address - Phone:910-483-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist