Provider Demographics
NPI:1801341557
Name:MINX, JILL (OTR/L)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MINX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S LIBERTY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1849
Mailing Address - Country:US
Mailing Address - Phone:423-736-4104
Mailing Address - Fax:
Practice Address - Street 1:958 TRADE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-5773
Practice Address - Country:US
Practice Address - Phone:423-254-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist