Provider Demographics
NPI:1447912886
Name:WIGGILL, JILLIAN ELIZABETH (MSOT, OTR)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:WIGGILL
Suffix:
Gender:F
Credentials:MSOT, OTR
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:ELIZABETH
Other - Last Name:LEMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSOT, OTR
Mailing Address - Street 1:134 INFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8026
Mailing Address - Country:US
Mailing Address - Phone:704-799-6824
Mailing Address - Fax:
Practice Address - Street 1:134 INFIELD CT
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8026
Practice Address - Country:US
Practice Address - Phone:704-799-6824
Practice Address - Fax:704-799-6825
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist