Provider Demographics
NPI:1972601086
Name:MOELLER, JILL R (OT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:MOELLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 RAIN CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7038
Mailing Address - Country:US
Mailing Address - Phone:512-338-4022
Mailing Address - Fax:512-338-4022
Practice Address - Street 1:6912 RAIN CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7038
Practice Address - Country:US
Practice Address - Phone:512-338-4022
Practice Address - Fax:512-338-4022
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T0090OtherBCBS
TX109371OtherSTATE BOARD