Healthcare Provider Details

I. General information

NPI: 1972635530
Provider Name (Legal Business Name): JILL M ELLIOTT MS, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 S STATE ROAD 135 SUITE C
GREENWOOD IN
46142-1443
US

IV. Provider business mailing address

1041 BENNINGTON CT
GREENWOOD IN
46143-7547
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-1110
  • Fax:
Mailing address:
  • Phone: 317-865-3150
  • Fax: 317-865-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31000432A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: