Provider Demographics
NPI:1215781042
Name:HILL, DIANNA SUE (COTAL)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:SUE
Last Name:HILL
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50196 STONECREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1933
Mailing Address - Country:US
Mailing Address - Phone:313-600-8027
Mailing Address - Fax:
Practice Address - Street 1:5669 LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-2817
Practice Address - Country:US
Practice Address - Phone:810-385-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007321225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty