Healthcare Provider Details

I. General information

NPI: 1124766431
Provider Name (Legal Business Name): JILL OPALESKY MS, ATR-BC, ITR-CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 STUART CIR UNIT 322
RICHMOND VA
23220-3784
US

IV. Provider business mailing address

413 STUART CIR UNIT 322
RICHMOND VA
23220-3784
US

V. Phone/Fax

Practice location:
  • Phone: 804-543-6319
  • Fax:
Mailing address:
  • Phone: 804-543-6319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: