Provider Demographics
NPI:1548151905
Name:STEPHENS, JILL E (COTA)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SALTY FIN DR
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-9837
Mailing Address - Country:US
Mailing Address - Phone:843-599-0869
Mailing Address - Fax:
Practice Address - Street 1:141 SALTY FIN DR
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-9837
Practice Address - Country:US
Practice Address - Phone:843-599-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC907A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant