Provider Demographics
NPI:1366729212
Name:EATON, JILL ANDREA (OTR)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANDREA
Last Name:EATON
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 1:3009 STATE ROUTE 40 N
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-2315
Mailing Address - Country:US
Mailing Address - Phone:518-692-2920
Mailing Address - Fax:
Practice Address - Street 1:76 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4912
Practice Address - Country:US
Practice Address - Phone:518-793-9048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006193-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist