Provider Demographics
NPI:1649491275
Name:LEMKE, JILL M (OT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:LEMKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:820 ROY STREET
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278
Mailing Address - Country:US
Mailing Address - Phone:320-839-4087
Mailing Address - Fax:320-839-4196
Practice Address - Street 1:1205 5TH AVE. N.
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MN
Practice Address - Zip Code:56296
Practice Address - Country:US
Practice Address - Phone:320-563-8269
Practice Address - Fax:320-839-4196
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102709225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN67000462Medicare PIN