Provider Demographics
NPI:1992921548
Name:NAIL, JILLIAN ROSE (OTR)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:ROSE
Last Name:NAIL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SOMERS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2758
Mailing Address - Country:US
Mailing Address - Phone:406-863-2017
Mailing Address - Fax:406-863-2018
Practice Address - Street 1:533 SOMERS AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2758
Practice Address - Country:US
Practice Address - Phone:406-863-2678
Practice Address - Fax:406-863-2018
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT838225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT661600OtherBCBS PROVIDER ID NUMBER
MT3400098Medicaid