Provider Demographics
NPI:1376882753
Name:HILL, MANDY G (OT)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:G
Last Name:HILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:L
Other - Last Name:GIANNOBILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-2663
Mailing Address - Fax:985-230-2665
Practice Address - Street 1:15813 PAUL VEGA MD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1426
Practice Address - Country:US
Practice Address - Phone:985-230-2663
Practice Address - Fax:985-230-2665
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ12459225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGMedicaid
LAPENDINGMedicare PIN