Provider Demographics
NPI:1386802163
Name:BIANCHI, JILL ERIN (COTA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ERIN
Last Name:BIANCHI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 10TH ST
Mailing Address - Street 2:PO BOX 505
Mailing Address - City:MANSON
Mailing Address - State:IA
Mailing Address - Zip Code:50563-7705
Mailing Address - Country:US
Mailing Address - Phone:712-469-3533
Mailing Address - Fax:
Practice Address - Street 1:1802 10TH ST
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:IA
Practice Address - Zip Code:50563-7705
Practice Address - Country:US
Practice Address - Phone:712-469-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00440224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant