Provider Demographics
NPI:1750112124
Name:HOMER, HILLARY DAWN (LMT)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:DAWN
Last Name:HOMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ADELAIDE CT
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3792
Mailing Address - Country:US
Mailing Address - Phone:360-580-0655
Mailing Address - Fax:
Practice Address - Street 1:711 HARRISON AVE STE E
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3542
Practice Address - Country:US
Practice Address - Phone:360-580-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
CO0023919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula