Provider Demographics
NPI:1386740777
Name:O'BRIEN, JILLIAN R (OTR/L)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:R
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHARLONATE DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9765
Mailing Address - Country:US
Mailing Address - Phone:207-615-1977
Mailing Address - Fax:
Practice Address - Street 1:125 PRESUMPSCOT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5225
Practice Address - Country:US
Practice Address - Phone:207-699-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1496225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME243990099Medicaid