Provider Demographics
NPI:1639296338
Name:BARRON, JILL SUZANNE (OTR, ATP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:BARRON
Suffix:
Gender:F
Credentials:OTR, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4313 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-3607
Mailing Address - Country:US
Mailing Address - Phone:605-331-4376
Mailing Address - Fax:605-782-2401
Practice Address - Street 1:2501 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2446
Practice Address - Country:US
Practice Address - Phone:605-782-2316
Practice Address - Fax:605-782-2301
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0392225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5832410Medicaid