Provider Demographics
NPI:1952047169
Name:MICKLEY, HILLARY (ATC)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:MICKLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 SALEM CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SIDNEY
Mailing Address - State:VA
Mailing Address - Zip Code:24467-2322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:663 SALEM CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT SIDNEY
Practice Address - State:VA
Practice Address - Zip Code:24467-2322
Practice Address - Country:US
Practice Address - Phone:540-460-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260014482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer