Provider Demographics
NPI:1649553744
Name:KORELL, JILLIAN CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:CHRISTINE
Last Name:KORELL
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 1:5350 E 22ND PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2235
Mailing Address - Country:US
Mailing Address - Phone:406-945-0539
Mailing Address - Fax:918-645-8686
Practice Address - Street 1:5110 S YALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7401
Practice Address - Country:US
Practice Address - Phone:918-492-2386
Practice Address - Fax:918-645-8686
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist