Provider Demographics
NPI:1609084458
Name:WHITE, JILL ANN (MAOTR)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MAOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BARBARA TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1201
Mailing Address - Country:US
Mailing Address - Phone:732-615-0213
Mailing Address - Fax:732-615-0213
Practice Address - Street 1:3 BARBARA TER
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-1201
Practice Address - Country:US
Practice Address - Phone:732-615-0213
Practice Address - Fax:732-615-0213
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00035700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist