Provider Demographics
NPI:1356057699
Name:LAWTON, JILLIAN SANDRA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:SANDRA
Last Name:LAWTON
Suffix:
Gender:
Credentials:MS, 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 1119
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-1119
Mailing Address - Country:US
Mailing Address - Phone:843-996-1471
Mailing Address - Fax:843-808-6986
Practice Address - Street 1:104 MALLORY DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6406
Practice Address - Country:US
Practice Address - Phone:843-996-1471
Practice Address - Fax:843-808-6986
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6887225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist