Provider Demographics
NPI:1386481232
Name:VANDERGAST, HILLARY KAYRIS (OTR/L)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:KAYRIS
Last Name:VANDERGAST
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:VANDER GAST
Other - Last Name:BAGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1325 PROMONTORY CREST VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3950
Mailing Address - Country:US
Mailing Address - Phone:719-453-9310
Mailing Address - Fax:
Practice Address - Street 1:6050 ERIN PARK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3488
Practice Address - Country:US
Practice Address - Phone:719-465-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0005977225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty