Provider Demographics
NPI:1659181964
Name:VANDERVELDE, HILARY (COTA)
Entity type:Individual
Prefix:
First Name:HILARY
Middle Name:
Last Name:VANDERVELDE
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 1:540 MEADOW RDG
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2985
Mailing Address - Country:US
Mailing Address - Phone:219-629-6947
Mailing Address - Fax:219-440-7931
Practice Address - Street 1:8626 WICKER AVE STE C
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9053
Practice Address - Country:US
Practice Address - Phone:219-440-7930
Practice Address - Fax:219-440-7931
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003659A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty