Provider Demographics
NPI:1710418736
Name:BRINKER, JILL (OTR)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BRINKER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27733 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6641
Mailing Address - Country:US
Mailing Address - Phone:586-427-6640
Mailing Address - Fax:586-427-6642
Practice Address - Street 1:27733 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6641
Practice Address - Country:US
Practice Address - Phone:586-427-6640
Practice Address - Fax:586-427-6642
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist