MEDICARE: MS. JILL ANDERSON MS, OTR

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	225XP0200X	Pediatric Occupational Therapist	001113-1	NY

General Provider Information

NPI Number	:	1295925212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL ANDERSON MS, OTR

Provider Business Mailing Address
First Line	:	404 HEMPSTEAD AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-2043
Country	:	US
Telephone Number	:	516-536-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 HEMPSTEAD AVE
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-2043
Country	:	US
Telephone Number	:	516-536-8232
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	01/05/2009

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