Provider Demographics
NPI:1801936521
Name:HILLEGAS, AUTUMN RENEE (OT)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:RENEE
Last Name:HILLEGAS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:RENEE
Other - Last Name:STOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2003 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9700
Mailing Address - Country:US
Mailing Address - Phone:706-282-4461
Mailing Address - Fax:706-282-4416
Practice Address - Street 1:2003 FALLS RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-9700
Practice Address - Country:US
Practice Address - Phone:706-282-4461
Practice Address - Fax:706-282-4416
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004196225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist