Provider Demographics
NPI:1649693615
Name:TYREE, JILL (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:TYREE
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 1:11669 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9204
Mailing Address - Country:US
Mailing Address - Phone:330-625-8006
Mailing Address - Fax:
Practice Address - Street 1:11669 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9204
Practice Address - Country:US
Practice Address - Phone:330-625-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT001865225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist