Provider Demographics
NPI:1104235837
Name:HILLMAN, KATIE (COTA/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 E LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1833
Mailing Address - Country:US
Mailing Address - Phone:602-400-6693
Mailing Address - Fax:
Practice Address - Street 1:2303 E LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1833
Practice Address - Country:US
Practice Address - Phone:602-400-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5915224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant