Provider Demographics
NPI:1659569242
Name:HILLIS, DENISE MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:HILLIS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-1002
Mailing Address - Country:US
Mailing Address - Phone:573-783-3993
Mailing Address - Fax:
Practice Address - Street 1:105 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-1002
Practice Address - Country:US
Practice Address - Phone:573-783-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018055224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant