Healthcare Provider Details

I. General information

NPI: 1316894397
Provider Name (Legal Business Name): JILLIAN NICOLE STONE MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 AUDUBON RD BLDG 1
WAKEFIELD MA
01880-1266
US

IV. Provider business mailing address

16 WOODRUFF AVE
MELROSE MA
02176-5213
US

V. Phone/Fax

Practice location:
  • Phone: 781-245-4446
  • Fax:
Mailing address:
  • Phone: 781-521-0332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTL36528
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: