Provider Demographics
NPI:1386840494
Name:CHAVIS, HILLARY MARIE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:MARIE
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26469 PORTOLA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4163
Mailing Address - Country:US
Mailing Address - Phone:949-616-0509
Mailing Address - Fax:
Practice Address - Street 1:24171 PAVION
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2200
Practice Address - Country:US
Practice Address - Phone:949-707-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9090225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist