Provider Demographics
NPI:1306348354
Name:HITCHCOCK, JILLIAN KAY (CPO)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:KAY
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 LYNN RIDGE DR APT 2F
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8920
Mailing Address - Country:US
Mailing Address - Phone:585-489-0829
Mailing Address - Fax:
Practice Address - Street 1:3410 EXECUTIVE DR STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7400
Practice Address - Country:US
Practice Address - Phone:919-803-5869
Practice Address - Fax:888-635-6138
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist