Provider Demographics
NPI:1194162198
Name:HILLERMAN, CONNIE (COTA/L)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HILLERMAN
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 1:8902 ZIER RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9240
Mailing Address - Country:US
Mailing Address - Phone:509-965-2080
Mailing Address - Fax:
Practice Address - Street 1:8902 ZIER RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9240
Practice Address - Country:US
Practice Address - Phone:509-965-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOC00000989224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant