Provider Demographics
NPI:1568588762
Name:DEMBROFF, HILLARY (OTR)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:DEMBROFF
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9484
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-2484
Mailing Address - Country:US
Mailing Address - Phone:530-543-2313
Mailing Address - Fax:
Practice Address - Street 1:1360 JOHNSON BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8220
Practice Address - Country:US
Practice Address - Phone:530-543-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 1040225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics