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NPI 1629194329

NPI 1629194329 : JILL MARKOVICH : POTTSVILLE, PA

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General NPI Number Information
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    NPI Number           |    1629194329
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    Entity Type          |    Individual 
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    Provider Name        |    JILL MARKOVICH
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    03/22/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    1000 SCHUYLKILL MANOR RD 
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    City                 |    POTTSVILLE
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    State                |    PA
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    Zip                  |    17901
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    Country              |    US
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    Telephone            |    570-622-9666
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    P.O. BOX 1 
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    City                 |    MARION HEIGHTS
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    State                |    PA
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    Zip                  |    17832
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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        |    224Z00000X
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    Taxonomy Name        |    Occupational Therapy Assistant
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    License Number       |    OP003343L
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    License Number State |    PA
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