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General NPI Number Information
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NPI Number | 1518269521
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Entity Type | Individual
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Provider Name | JILL MARIE MCCORMACK MOTR/L
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Gender | Female
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 5301 N FEDERAL HWY SUITE 135
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City | BOCA RATON
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State | FL
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Zip | 33487-4917
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Country | US
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Telephone | 561-674-0016
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Fax |
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Provider Business Mailing Address
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Address Line | 9852 NW 6TH PL
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City | PLANTATION
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State | FL
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Zip | 33324-4939
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Country | US
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Telephone | 413-519-1432
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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 | 11996
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License Number State | FL
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