Provider Demographics
NPI:1689115883
Name:AYSON, JILLIAN (ATC, LAT, EMT-B)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:AYSON
Suffix:
Gender:F
Credentials:ATC, LAT, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-1923
Mailing Address - Country:US
Mailing Address - Phone:914-337-9300
Mailing Address - Fax:914-395-4515
Practice Address - Street 1:171 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-1923
Practice Address - Country:US
Practice Address - Phone:914-337-9300
Practice Address - Fax:914-395-4515
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003130-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer