Provider Demographics
NPI:1073646782
Name:JONES, JILL PETERSON (LOTR)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:PETERSON
Last Name:JONES
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4222
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:504-828-8935
Practice Address - Street 1:101 RIVER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4222
Practice Address - Country:US
Practice Address - Phone:504-828-7696
Practice Address - Fax:504-828-8935
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11839225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H338C526Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO