Provider Demographics
NPI:1942077169
Name:ALTOBELLA, JILLIAN JOYCE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JOYCE
Last Name:ALTOBELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 VIA LA CANTERA APT 217
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2535
Mailing Address - Country:US
Mailing Address - Phone:773-759-8281
Mailing Address - Fax:
Practice Address - Street 1:6870 HEUERMANN RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256-9605
Practice Address - Country:US
Practice Address - Phone:210-840-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218180224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant