Provider Demographics
NPI:1053528992
Name:AYRES, JILL MARIE (MS, ATC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:AYRES
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 S SHASTA WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-5242
Mailing Address - Country:US
Mailing Address - Phone:714-633-7294
Mailing Address - Fax:714-633-8016
Practice Address - Street 1:574 S SHASTA WAY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-5242
Practice Address - Country:US
Practice Address - Phone:714-633-7294
Practice Address - Fax:714-633-8016
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9140102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer