Provider Demographics
NPI:1215902689
Name:HILLMON, DESIREE (ATC)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:
Last Name:HILLMON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 BLACK OAK DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1811
Mailing Address - Country:US
Mailing Address - Phone:419-841-2989
Mailing Address - Fax:419-470-5424
Practice Address - Street 1:2345 MAIN ST
Practice Address - Street 2:HEALTHTRAX INTERNATIONAL INC
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2211
Practice Address - Country:US
Practice Address - Phone:800-998-0800
Practice Address - Fax:860-657-2596
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0000632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer