Provider Demographics
NPI:1972892412
Name:ILLIG, JASON ANDREW (COTA/L)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ANDREW
Last Name:ILLIG
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 T REX AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4479
Mailing Address - Country:US
Mailing Address - Phone:412-726-7663
Mailing Address - Fax:
Practice Address - Street 1:60 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1806
Practice Address - Country:US
Practice Address - Phone:412-831-6050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002286L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant