Provider Demographics
NPI:1154215697
Name:HILL, OCTAVIA W
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:W
Last Name:HILL
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 1:604 SOFIA LN APT H
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-0255
Mailing Address - Country:US
Mailing Address - Phone:980-287-3469
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:604 SOFIA LN APT H
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-0255
Practice Address - Country:US
Practice Address - Phone:980-287-3469
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor