Healthcare Provider Details

I. General information

NPI: 1760723548
Provider Name (Legal Business Name): JUANITA MARIE HILTNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 N 19TH AVE SUITE 200
PHOENIX AZ
85021-7967
US

IV. Provider business mailing address

484 E CLOVER CREEK DR
FLAGSTAFF AZ
86001-7061
US

V. Phone/Fax

Practice location:
  • Phone: 888-873-4221
  • Fax: 888-543-2289
Mailing address:
  • Phone: 928-525-6730
  • Fax: 928-774-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3298
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: