Provider Demographics
NPI:1063986453
Name:PICARD-BUSKY, JILLIAN (ATS)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:PICARD-BUSKY
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 TIMBER DR
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1227
Mailing Address - Country:US
Mailing Address - Phone:860-429-7990
Mailing Address - Fax:
Practice Address - Street 1:72 TIMBER DR
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-1227
Practice Address - Country:US
Practice Address - Phone:860-429-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer