Provider Demographics
NPI:1073870176
Name:HILLIS, LORI M
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:M
Last Name:HILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13750 BYNUM LN
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1465
Mailing Address - Country:US
Mailing Address - Phone:580-465-2941
Mailing Address - Fax:
Practice Address - Street 1:1301 KIOWA ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2280
Practice Address - Country:US
Practice Address - Phone:580-226-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor