Provider Demographics
NPI:1770591059
Name:YARBROUGH, JILL ANNETTE (LMT RM)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNETTE
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:LMT RM
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:ANNETTE
Other - Last Name:MCCASLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:808 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:NM
Mailing Address - Zip Code:88231
Mailing Address - Country:US
Mailing Address - Phone:505-394-1466
Mailing Address - Fax:
Practice Address - Street 1:808 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:NM
Practice Address - Zip Code:88231
Practice Address - Country:US
Practice Address - Phone:505-394-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM# 2383225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist