Provider Demographics
NPI:1447731518
Name:RYAN, JILLIAN D (OTR)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:D
Last Name:RYAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 REESE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1638
Mailing Address - Country:US
Mailing Address - Phone:716-338-8452
Mailing Address - Fax:
Practice Address - Street 1:9520 FREDONIA STOCKTON RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-9518
Practice Address - Country:US
Practice Address - Phone:716-672-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027166225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist