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General NPI Number Information
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NPI Number | 1740353119
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Entity Type | Individual
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Provider Name | JEAN MARIE GILL MSOTRL
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 58850 8685 RD
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City | WATERBURY
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State | NE
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Zip | 68785-3023
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Country | US
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Telephone | 712-251-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 58850 8685 RD
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City | WATERBURY
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State | NE
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Zip | 68785-3023
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Country | US
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Telephone | 402-638-2301
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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 | 01332
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License Number State | IA
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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 | 1084
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0646
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License Number State | SD
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