Provider Demographics
NPI:1407906829
Name:HILL, WINNIFRED H (OT)
Entity Type:Individual
Prefix:
First Name:WINNIFRED
Middle Name:H
Last Name:HILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10830 SUSHANA CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8394
Mailing Address - Country:US
Mailing Address - Phone:907-696-4266
Mailing Address - Fax:907-696-4266
Practice Address - Street 1:10830 SUSHANA CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8394
Practice Address - Country:US
Practice Address - Phone:907-696-4266
Practice Address - Fax:907-696-4266
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK518225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOT5649Medicaid