Provider Demographics
NPI:1952531360
Name:FANTASIA, HILIARY A (OT)
Entity Type:Individual
Prefix:
First Name:HILIARY
Middle Name:A
Last Name:FANTASIA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 STROUD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1016
Mailing Address - Country:US
Mailing Address - Phone:315-415-3437
Mailing Address - Fax:
Practice Address - Street 1:1101 STROUD AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1016
Practice Address - Country:US
Practice Address - Phone:315-415-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016095-1225X00000X
CA18275225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist