Provider Demographics
NPI:1306030861
Name:JILL STEDRONSKY MS, OTR, LLC
Entity type:Organization
Organization Name:JILL STEDRONSKY MS, OTR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:STEDRONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR
Authorized Official - Phone:303-332-9171
Mailing Address - Street 1:11832 W ASBURY PL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11832 W ASBURY PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4400
Practice Address - Country:US
Practice Address - Phone:303-332-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO977159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty