Provider Demographics
NPI:1093109225
Name:LAURENT, JILLIAN (OTR)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2014 KENDALL AVE
Mailing Address - Street 2:APT #1
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-3914
Mailing Address - Country:US
Mailing Address - Phone:920-242-6958
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF WISCONSIN HOSPITAL AND CLINICS
Practice Address - Street 2:600 HIGHLAND AVENUE, MAIL STOP 2424
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-2424
Practice Address - Country:US
Practice Address - Phone:608-263-8060
Practice Address - Fax:608-262-7679
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5667-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist