Provider Demographics
NPI:1700089943
Name:HILLICOSS, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HILLICOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CHEBEAGUE ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04017-3702
Mailing Address - Country:US
Mailing Address - Phone:207-781-8881
Mailing Address - Fax:
Practice Address - Street 1:50 DEPOT RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1211
Practice Address - Country:US
Practice Address - Phone:207-781-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME373350OtherTEACHER CERTIFICATE