MEDICARE: JILLIAN NICKLAS ELLIOTT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC010225	PA

General Provider Information

NPI Number	:	1093027070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN NICKLAS ELLIOTT OTR/L

Provider Business Mailing Address
First Line	:	3311 PORTRAIT WAY
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17202-8183
Country	:	US
Telephone Number	:	717-360-4874
Fax Number	:

Provider Business Practice Location Address
First Line	:	2075 SCOTLAND AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1451
Country	:	US
Telephone Number	:	717-263-8545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	09/17/2010

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