Provider Demographics
NPI:1982140067
Name:MIKLOS, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MIKLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:STEFFENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:SD
Mailing Address - Zip Code:57212-2322
Mailing Address - Country:US
Mailing Address - Phone:605-203-1638
Mailing Address - Fax:
Practice Address - Street 1:108 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:SD
Practice Address - Zip Code:57212-2322
Practice Address - Country:US
Practice Address - Phone:605-203-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD218A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant