Provider Demographics
NPI:1790161503
Name:HILLMON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HILLMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:STWALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 SENIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:KS
Mailing Address - Zip Code:66871
Mailing Address - Country:US
Mailing Address - Phone:785-733-2666
Mailing Address - Fax:
Practice Address - Street 1:407 SENIOR ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:KS
Practice Address - Zip Code:66871
Practice Address - Country:US
Practice Address - Phone:785-733-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-01130224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant