Provider Demographics
NPI:1972562932
Name:KIRKPATRICK, JILL (OTR)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:JILL
Other - Last Name:KIRKPATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:2808 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-7854
Mailing Address - Country:US
Mailing Address - Phone:903-780-6596
Mailing Address - Fax:903-881-6010
Practice Address - Street 1:2808 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7854
Practice Address - Country:US
Practice Address - Phone:903-780-6596
Practice Address - Fax:903-881-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101977225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089220001Medicaid