Jill J Broyles, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A1905 Issued in AR

Practice address

23 Parkcliff Dr
Holiday Island, AR 72631-8045

Phone

(479) 363-6422

Fax

(479) 363-6763

NPI assigned

Jan 24, 2013

Last updated

Mar 24, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wolf Wellness Center, PLLC

  • Rehabilitation Clinic/Center
  • Holiday Island, AR
  • NPI 1588037196
  NPD
• Spine and Sports Therapy LLC

  • Physical Therapist
  • Lowell, AR
  • NPI 1730454935
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1902144058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25061 FAT BOB TRL",
            "city": "SHELL KNOB",
            "state": "MO",
            "postal_code": "657477889",
            "telephone_number": "316-204-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 PARKCLIFF DR",
            "city": "HOLIDAY ISLAND",
            "state": "AR",
            "postal_code": "726318045",
            "telephone_number": "479-363-6422",
            "fax_number": "479-363-6763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "JILL",
        "middle_name": "J",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "KS",
            "license": "3786",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "MO",
            "license": "2021006128",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "KS",
            "license": "1800833",
            "primary": false
        },
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Air Evac EMS, Inc. (Air Evac Lifeteam)
• Andy Langston, OD, PA
• Jason Ayers, PTA
• Lilly Bickford, COTA/L
• Terry William Bushay, D.D.S.
• Sidney Carnes
• Sarah Davis
• Rene Charles Duffourc III, M.D.
• Eureka Springs Hospital (Eureka Springs Hospital Home Health and Hospice)

• Occupational Therapy Assistant in Holiday Island, AR
• Providers in Holiday Island, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.