Provider Demographics
NPI:1275180333
Name:O'CONNOR, HILLARY RENEE
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:RENEE
Last Name:O'CONNOR
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 1:3019 ROSEWOOD LN SE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1223
Mailing Address - Country:US
Mailing Address - Phone:763-772-6373
Mailing Address - Fax:
Practice Address - Street 1:3019 ROSEWOOD LN SE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1223
Practice Address - Country:US
Practice Address - Phone:763-772-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist