Provider Demographics
NPI:1659708402
Name:FAULKNER, JILLIAN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHITLA DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1348
Mailing Address - Country:US
Mailing Address - Phone:508-816-9058
Mailing Address - Fax:
Practice Address - Street 1:90 TAUNTON ST
Practice Address - Street 2:
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1349
Practice Address - Country:US
Practice Address - Phone:508-384-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3322224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant