Provider Demographics
NPI:1689635617
Name:WITHINGTON, JILLIAN LEE (MS,ATC,CSCS)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:LEE
Last Name:WITHINGTON
Suffix:
Gender:F
Credentials:MS,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MAJESTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-2359
Mailing Address - Country:US
Mailing Address - Phone:401-781-4273
Mailing Address - Fax:
Practice Address - Street 1:8 ABBOTT PARK PL
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3703
Practice Address - Country:US
Practice Address - Phone:401-598-1631
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT001652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer