Provider Demographics
NPI:1710172713
Name:HODGSON, JILL L (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:L
Last Name:HODGSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:218 ANTLER LAKE ROAD
Mailing Address - City:WEVERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12886-0121
Mailing Address - Country:US
Mailing Address - Phone:518-251-5434
Mailing Address - Fax:518-251-2367
Practice Address - Street 1:165 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH CREEK
Practice Address - State:NY
Practice Address - Zip Code:12853
Practice Address - Country:US
Practice Address - Phone:518-251-4201
Practice Address - Fax:518-251-2367
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014660225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014660-1OtherNYS OT LICENSE