Provider Demographics
NPI:1700335874
Name:BRILL, JORDYN (OT)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:BRILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 W CUNNINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8414
Mailing Address - Country:US
Mailing Address - Phone:479-200-6026
Mailing Address - Fax:
Practice Address - Street 1:1716 W CUNNINGHAM AVE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8414
Practice Address - Country:US
Practice Address - Phone:479-200-6026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist