Provider Demographics
NPI:1124766431
Name:OPALESKY, JILL (MS, ATR-BC, ITR-CS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:OPALESKY
Suffix:
Gender:F
Credentials:MS, ATR-BC, ITR-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 STUART CIR UNIT 322
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3784
Mailing Address - Country:US
Mailing Address - Phone:804-543-6319
Mailing Address - Fax:
Practice Address - Street 1:413 STUART CIR UNIT 322
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3784
Practice Address - Country:US
Practice Address - Phone:804-543-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist