Provider Demographics
NPI:1780930651
Name:IRWIN, JILLIENE (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:JILLIENE
Middle Name:
Last Name:IRWIN
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 1:2114 N FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5891
Mailing Address - Country:US
Mailing Address - Phone:724-222-5433
Mailing Address - Fax:
Practice Address - Street 1:2114 N FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5891
Practice Address - Country:US
Practice Address - Phone:724-222-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist