Provider Demographics
NPI:1205126356
Name:HILL, CARRIE MARIE (MA, OTR/L)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:MARIE
Last Name:HILL
Suffix:
Gender:F
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 EAST RIDGECREST BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555
Mailing Address - Country:US
Mailing Address - Phone:760-371-1411
Mailing Address - Fax:760-371-1410
Practice Address - Street 1:935 E RIDGECREST BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-4368
Practice Address - Country:US
Practice Address - Phone:760-371-1411
Practice Address - Fax:760-371-1410
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11522225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist