Healthcare Provider Details

I. General information

NPI: 1356440051
Provider Name (Legal Business Name): JILL ANN NYE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL ANN MAROVICH OTR

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10257 W LINCOLN HIGHWAY
FRANKFORT IL
60423
US

IV. Provider business mailing address

14486 CREEK CROSSING DRIVE
ORLAND PARK IL
60467
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-1117
  • Fax: 815-469-1103
Mailing address:
  • Phone: 708-460-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: