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General NPI Number Information
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NPI Number | 1104480250
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Entity Type | Individual
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Provider Name | JILLIAN DICOLA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 734-763-6709
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Fax |
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Provider Business Mailing Address
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Address Line | 5005 N. PIEDRAS ST
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City | EL PASO
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State | TX
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Zip | 79920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 18367
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 119994
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License Number State | TX
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