Provider Demographics
NPI:1558656413
Name:HILLIARD, KATHLEEN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10872 SIMPKINS LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-6927
Mailing Address - Country:US
Mailing Address - Phone:618-982-9328
Mailing Address - Fax:
Practice Address - Street 1:10872 SIMPKINS LN
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6927
Practice Address - Country:US
Practice Address - Phone:618-982-9328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004344225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant