Provider Demographics
NPI:1609042191
Name:KORDONOWY, JILL DIANE (COTA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DIANE
Last Name:KORDONOWY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3731
Mailing Address - Country:US
Mailing Address - Phone:406-222-0672
Mailing Address - Fax:405-222-1406
Practice Address - Street 1:510 S 14TH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3731
Practice Address - Country:US
Practice Address - Phone:406-222-0672
Practice Address - Fax:405-222-1406
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT317224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant