Provider Demographics
NPI:1295988913
Name:CAFARELLA, JILLIAN ALISON (OTR/L)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ALISON
Last Name:CAFARELLA
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 1:36 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2404
Mailing Address - Country:US
Mailing Address - Phone:631-444-5366
Mailing Address - Fax:
Practice Address - Street 1:36 MARION AVE
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2404
Practice Address - Country:US
Practice Address - Phone:631-444-5366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011864-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist