Provider Demographics
NPI:1346568045
Name:HILL, MONIQUE A (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:A
Last Name:HILL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 SW MANOR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4181
Mailing Address - Country:US
Mailing Address - Phone:816-525-2665
Mailing Address - Fax:
Practice Address - Street 1:402 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720-9277
Practice Address - Country:US
Practice Address - Phone:816-297-2107
Practice Address - Fax:816-297-4321
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009020246224Z00000X
KS18-00697224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant