Provider Demographics
NPI:1538742911
Name:GRGURICH, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GRGURICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 FOX TROTTER LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-6709
Mailing Address - Country:US
Mailing Address - Phone:636-667-0963
Mailing Address - Fax:
Practice Address - Street 1:1481 MARBACH DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4636
Practice Address - Country:US
Practice Address - Phone:636-239-1941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty