Individual
JILLIAN FARESTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 SPRING ST APT 1114, SILVER SPRING, MD 20910-4036
(301) 788-6015
Mailing address
1001 SPRING ST APT 1114, SILVER SPRING, MD 20910-4036
(301) 788-6015
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11172077020
—
MD
Enumeration date
06/17/2015
Last updated
06/17/2015
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