Provider Demographics
NPI:1962286849
Name:HILL, SKYE BLUE (COTA)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:BLUE
Last Name:HILL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 HAFNER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-6214
Mailing Address - Country:US
Mailing Address - Phone:931-278-1090
Mailing Address - Fax:
Practice Address - Street 1:250 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-5186
Practice Address - Country:US
Practice Address - Phone:931-245-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3414224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification