Provider Demographics
NPI:1780359406
Name:BIRKNER, JILL RENEE (COTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:BIRKNER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27420 ROBINSON RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE NORTH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-8957
Mailing Address - Country:US
Mailing Address - Phone:832-559-2309
Mailing Address - Fax:
Practice Address - Street 1:27103 BROADFORD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8042
Practice Address - Country:US
Practice Address - Phone:281-733-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216964224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant